Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 363LP0200X | Nurse Practitioner - Pediatrics | 4704162094 | MI |
NPI | 1033106224 |
---|---|
Provider Name | Kimberly Dawn Rood |
First Address | Detroit, MI 48201-2119 |
Second Address | Detroit, MI 48201-2119 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 03/10/2005 |
Last Update Date | 09/02/2012 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
4517881 | (05) | MI |
5008601810 | BLUE CROSS/BLUE SHIELD (01) | MI |