Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 111NN1001X | Nutrition | X010742-1 | NY |
NPI | 1104903640 |
---|---|
Provider Name | Kimberly Susan Demay |
First Address | Penn Yan, NY 14527 |
Second Address | Penn Yan, NY 14527 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 01/11/2006 |
Last Update Date | 15/12/2020 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
164536AN | (02) | NY |