Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 213E00000X | Podiatrist | CPO-1994 | TX |
Y | 222Z00000X | Podiatrist | CPO-1994 | TX |
N | 213E00000X | Podiatrist | LPO-362 | TX |
N | 222Z00000X | Podiatrist | LPO-362 | TX |
N | 224P00000X | Prosthetist | CPO-1994 | TX |
N | 224P00000X | Prosthetist | LPO-362 | TX |
NPI | 1487767745 |
---|---|
Provider Name | Kimi Lauren Van Wie |
First Address | Pearland, TX 77584-1754 |
Second Address | Houston, TX 77030-4211 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 17/08/2006 |
Last Update Date | 07/10/2008 |