Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 363LC0200X | Nurse Practitioner - Critical Care Medicine | SP019751 | PA |
NPI | 1568921161 |
---|---|
Provider Name | Ms. Kelly M Cimino |
First Address | West Chester, PA 19380-4412 |
Second Address | West Chester, PA 19380-4412 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 14/03/2019 |
Last Update Date | 06/06/2019 |