Specialty |
Taxonomy Code | Specialty Code | Provider Type | |
Family |
363LF0000X | 50 | Nurse Practitioner |
| NPI Number | 1215399522 |
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| LBN Legal business name | KUMUDA FAMILY HEALTH CARE | ||||
| Authorized official | KIMBERLY JACKSON - (OWNER) | ||||
| Entity | Organization | ||||
| Organization subpart 1 | No | ||||
| Enumeration date | 03/25/2016 | ||||
| Last updated | 03/25/2016 - About 10 years ago | ||||
| Identifiers |
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