Individual
KIMBERLY GRANT MANSELL
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
DO
Contact information
Practice address
2500 HARBOR BLVD, PORT CHARLOTTE, FL 33952-5000
(941) 625-4155
(941) 625-4155
Mailing address
PO BOX 510209, PUNTA GORDA, FL 33951-0209
(941) 347-8317
Taxonomy
Speciality
Code
Description
License number
State
207P00000X
Emergency Medicine Physician
Primary
A-1350-06
NM
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
PENDING
—
NM
Enumeration date
05/12/2006
Last updated
07/08/2007
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