Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207PE0004X | Emergency Medical Services | MD20308 | OR |
N | 207Q00000X | Family Doctor | MD20308 | OR |
NPI | 1174569156 |
---|---|
Provider Name | Kimberly Cronin |
First Address | Eugene, OR 97440-0569 |
Second Address | Cottage Grove, OR 97424-9700 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 20/06/2006 |
Last Update Date | 03/11/2010 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
084736 | (05) | OR |
F93936 | (02) |