Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 363LA2100X | Nurse Practitioner - Acute Care | SP008054 | PA |
NPI | 1023091394 |
---|---|
Provider Name | Ms. Kimberly A Andersen |
First Address | Lancaster, PA 17603-2964 |
Second Address | Lancaster, PA 17603-2964 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 21/11/2005 |
Last Update Date | 25/11/2013 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
Q02618 | (02) |