Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 1223X0400X | Orthodontists | DS036852 | PA |
NPI | 1063839769 |
---|---|
Provider Name | Kimberly Christie |
First Address | Media, PA 19063-1763 |
Second Address | Media, PA 19063-1763 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 20/03/2014 |
Last Update Date | 20/03/2014 |