Individual
KIMBERLY LYNN HAUNER
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
NP
Contact information
Practice address
1300 W LODI AVE, SUITE P, LODI, CA 95242-3000
(209) 369-7493
Mailing address
600 COFFEE RD, MODESTO, CA 95355-4201
(209) 524-1211
Taxonomy
Speciality
Code
Description
License number
State
163W00000X
Registered Nurse
RN488842
CA
363LP0200X
Pediatric Nurse Practitioner
Primary
NP11149
CA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
RN88842
—
CA
Enumeration date
04/25/2006
Last updated
05/11/2010
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