Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 363LP0200X | Nurse Practitioner - Pediatrics | C-105998 | IA |
NPI | 1013969435 |
---|---|
Provider Name | Vanessa Alexandra Kimm |
First Address | Iowa City, IA 52242-1117 |
Second Address | Iowa City, IA 52242 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 16/05/2006 |
Last Update Date | 13/12/2018 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
Q12162 | (02) |