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Individual

ELIZABETH KIDDE

Active
Sole proprietor
No

Provider details

NPI number
Gender
F
Credential
CPNP

Contact information

Practice address
4650 W SUNSET BLVD # 54, LOS ANGELES, CA 90027-6062
(323) 361-5027
Mailing address
4650 W SUNSET BLVD # 54, LOS ANGELES, CA 90027-6062
(323) 361-5027

Taxonomy

Speciality
Code
Description
License number
State
363LP0200X
Pediatric Nurse Practitioner
Primary
95000938
CA
363LP0200X
Pediatric Nurse Practitioner
RN264689
MA

Other

Other identifiers
Code
Description
Identifier
Issuer
State
01
95000938
NP LICENSE
CA
01
95037727
RN
CA
Enumeration date
01/05/2012
Last updated
12/13/2018
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