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General NPI Number Information
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NPI Number | 1063871770
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Entity Type | Individual
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Provider Name | KIMBERLY GANGWER
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Gender | Female
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Dates
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Enumeration Date | 02/23/2016
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Last Update Date | 03/30/2016
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Provider Practice Location Address
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Address Line | 5177 MCCARTY LN
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City | LAFAYETTE
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State | IN
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Zip | 47905-8764
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Country | US
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Telephone | 765-448-8000
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Fax |
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Provider Business Mailing Address
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Address Line | PO BOX 5545
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City | LAFAYETTE
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State | IN
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Zip | 47903-5545
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Country | US
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Telephone | 765-448-8000
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 246ZC0007X
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Taxonomy Name | Surgical Assistant
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License Number | CERT 92231
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License Number State | IN
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