Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 207PE0004X | Emergency Medical Services | 239622 | MA |
NPI | 1215037403 |
---|---|
Provider Name | Kimberly D'eramo |
First Address | Durango, CO 81302-0957 |
Second Address | Hesperus, CO 81326-8709 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 25/09/2006 |
Last Update Date | 17/08/2016 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
843825299B | (05) | GA |