Individual
KIMBERLY SUE BLACK
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
RN
Contact information
Practice address
7150 CLEARVISTA DR, INDIANAPOLIS, IN 46256-1695
(317) 509-5321
Mailing address
7150 CLEARVISTA DR, INDIANAPOLIS, IN 46256-1695
(317) 621-5017
Taxonomy
Speciality
Code
Description
License number
State
163WG0000X
General Practice Registered Nurse
Primary
28097369A
IN
Other
Enumeration date
09/15/2017
Last updated
09/15/2017
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