Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 363LN0000X | Nurse Practitioner - Neonatal | 3009126 | KY |
NPI | 1073901609 |
---|---|
Provider Name | Mrs. Georgia Fielder |
First Address | Edgewood, KY 41017-3403 |
Second Address | Edgewood, KY 41017-3403 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 05/01/2015 |
Last Update Date | 11/05/2017 |