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General NPI Number Information
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NPI Number | 1295791432
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Entity Type | Individual
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Provider Name | KIMBERLY LYNN HAUNER NP
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Gender | Female
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Dates
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Enumeration Date | 04/25/2006
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Last Update Date | 05/11/2010
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Provider Practice Location Address
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Address Line | 1300 W LODI AVE SUITE P
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City | LODI
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State | CA
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Zip | 95242-3000
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Country | US
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Telephone | 209-369-7493
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Fax |
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Provider Business Mailing Address
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Address Line | 600 COFFEE RD
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City | MODESTO
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State | CA
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Zip | 95355-4201
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Country | US
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Telephone | 209-524-1211
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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 | 363LP0200X
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Taxonomy Name | Pediatric Nurse Practitioner
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License Number | NP11149
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License Number State | CA
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Taxonomy #2
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Taxonomy Code | 163W00000X
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Taxonomy Name | Registered Nurse
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License Number | RN488842
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License Number State | CA
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