Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 176B00000X | Midwife | 75745 | KS |
NPI | 1013267319 |
---|---|
Provider Name | Kristin Deann Perez |
First Address | Topeka, KS 66604 |
Second Address | Topeka, KS 66604 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 13/09/2012 |
Last Update Date | 08/11/2013 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
068002197 | MEDICARE PTAN (01) | KS |
200971830A | (05) | KS |