Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 363LW0102X | Nurse Practitioner - Women's Health | 23233 | CA |
NPI | 1043646193 |
---|---|
Provider Name | Kimberly Sellers |
First Address | San Diego, CA 92108-3538 |
Second Address | San Diego, CA 92108-3538 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 20/09/2013 |
Last Update Date | 20/09/2013 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
23233 | (02) | CA |