Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 363LF0000X | Nurse Practitioner - Family Medicine | 95003905 | CA |
N | 363LP2300X | Nurse Practitioner - Primary Care | 95003905 | CA |
NPI | 1023482023 |
---|---|
Provider Name | Mrs. Kimberly Rae Stalnaker |
First Address | Oceanside, CA 92054-4039 |
Second Address | Temecula, CA 92592-2915 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 15/11/2015 |
Last Update Date | 01/09/2016 |