Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 176B00000X | Midwife |
NPI | 1093208183 |
---|---|
Provider Name | Mrs. Kimberly S Rodriguez |
First Address | Bear Creek, PA 18602 |
Second Address | Bear Creek, PA 18602 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 13/06/2018 |
Last Update Date | 13/06/2018 |