Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 2080A0000X | Adolescent Medicine | 04 31126 | KS |
NPI | 1083799621 |
---|---|
Provider Name | Rebecca S Klingler |
First Address | Manhattan, KS 66502-2770 |
Second Address | Manhattan, KS 66502-2770 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 25/10/2006 |
Last Update Date | 09/03/2012 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
105516 | BLUE SHIELD (01) | KS |
2000383260A | (05) | KS |