Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 176B00000X | Midwife | MW008566L | PA |
NPI | 1003913823 |
---|---|
Provider Name | Ms. Kathleen M Nishida |
First Address | Philadelphia, PA 19146-3506 |
Second Address | Philadelphia, PA 19124-3602 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 20/09/2006 |
Last Update Date | 06/04/2017 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
001792598 | (05) | PA |