Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 363LN0005X | Nurse Practitioner - Neonatal (Critical Care) | R1274738 | MN |
NPI | 1154638476 |
---|---|
Provider Name | Loreen L Kimble |
First Address | Saint Paul, MN 55102-2346 |
Second Address | Saint Paul, MN 55102-2346 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 08/09/2010 |
Last Update Date | 08/09/2010 |