Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 363LP2300X | Nurse Practitioner - Primary Care | 4704248160 | MI |
NPI | 1053727297 |
---|---|
Provider Name | Mrs. Kimberly Shaw Brown |
First Address | Saginaw, MI 48604-8200 |
Second Address | Saginaw, MI 48604-8200 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 09/07/2014 |
Last Update Date | 07/08/2014 |