Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 2251C2600X | Cardiopulmonary | 222Q00000X | KY |
NPI | 1629296769 |
---|---|
Provider Name | Ms. Kelly Erin Middendorf |
First Address | Edgewood, KY 41017-3371 |
Second Address | Edgewood, KY 41017-3371 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 23/04/2007 |
Last Update Date | 08/07/2007 |