Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 363L00000X | Nurse Practitioner | 234658 | AZ |
NPI | 1003450925 |
---|---|
Provider Name | Kimberly Ann Flores |
First Address | Peoria, AZ 85383-5819 |
Second Address | Peoria, AZ 85383-5819 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 04/11/2019 |
Last Update Date | 12/11/2019 |