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General NPI Number Information
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NPI Number | 1982603619
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Entity Type | Individual
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Provider Name | SUSAN MARY KIM NP
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Gender | Female
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Dates
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Enumeration Date | 07/15/2005
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Last Update Date | 09/01/2021
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Provider Practice Location Address
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Address Line | 1350 LOCUST ST STE 105
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City | PITTSBURGH
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State | PA
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Zip | 15219-4738
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Country | US
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Telephone | 412-232-8840
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Fax | 412-232-3690
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Provider Business Mailing Address
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Address Line | 1350 LOCUST ST STE 105
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City | PITTSBURGH
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State | PA
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Zip | 15219-4738
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Country | US
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Telephone | 412-232-8840
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Fax | 412-232-3690
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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 | 363L00000X
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Taxonomy Name | Nurse Practitioner
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License Number | SP000893C
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License Number State | PA
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Taxonomy #2
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Taxonomy Code | 363LA2200X
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Taxonomy Name | Adult Health Nurse Practitioner
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License Number | SP000893C
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License Number State | PA
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