Individual
KYLIE CHIVINGTON
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
MT-BC, NICU-MT, NMT
Contact information
Practice address
119 S.18TH STREET, LEBANON, PA 17042-5011
(717) 468-1684
Mailing address
2221 SILVER LN, WILLOW STREET, PA 17584-9613
(717) 606-2513
Taxonomy
Speciality
Code
Description
License number
State
171W00000X
Contractor
Primary
12202
FL
Other
Enumeration date
06/01/2016
Last updated
08/07/2016
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