Healthcare Provider Details

I. General information

NPI: 1891924809
Provider Name (Legal Business Name): KINZIE ADELE NORRIS M.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: KINZIE ADELE MATLOCK

II. Dates (important events)

Enumeration Date: 07/11/2009
Last Update Date: 02/14/2017
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

301 N 27TH ST SUITE 11
NORFOLK NE
68701-4401
US

IV. Provider business mailing address

301 N 27TH ST STE 11
NORFOLK NE
68701-4401
US

V. Phone/Fax

Practice location:
  • Phone: 405-880-0316
  • Fax: 402-844-8122
Mailing address:
  • Phone: 405-880-0316
  • Fax: 402-844-8144

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2086X0206X
TaxonomySurgical Oncology Physician
License Number29863
License Number StateNE

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: