Individual
KIMBERLEY F GANGWISH
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
PA
Contact information
Practice address
620 N DIERS AVE, STE 200, GRAND ISLAND, NE 68803-4984
(308) 384-5400
(308) 384-5201
Mailing address
620 N DIERS AVE, STE. 200, GRAND ISLAND, NE 68803-4984
(308) 384-5400
(308) 384-5201
Taxonomy
Speciality
Code
Description
License number
State
363AS0400X
Surgical Physician Assistant
Primary
427
NE
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
47054564512
—
NE
Enumeration date
05/28/2005
Last updated
10/02/2007
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