Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 2080A0000X | Adolescent Medicine | NV7987 | NV |
NPI | 1114003498 |
---|---|
Provider Name | Ms. Marcy A. Kulic |
First Address | Henderson, NV 89014-2631 |
Second Address | Henderson, NV 89014-2631 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 28/10/2006 |
Last Update Date | 04/09/2012 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
002019884 | (05) | NV |