Individual
MISS KIMBERLY ANN DEFATTA
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
PNP
Contact information
Practice address
8268 164TH ST, JAMAICA, NY 11432-1121
(718) 883-4500
Mailing address
5631 226TH ST, APT 1, OAKLAND GARDENS, NY 11364-2044
Taxonomy
Speciality
Code
Description
License number
State
363LP0200X
Pediatric Nurse Practitioner
Primary
F381894-1
NY
Other
Enumeration date
07/11/2007
Last updated
07/11/2007
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