Provider Demographics
NPI:1225312796
Name:MCDANIEL KEITH, KIMLIN (RN, IBCLC)
Entity Type:Individual
Prefix:
First Name:KIMLIN
Middle Name:
Last Name:MCDANIEL KEITH
Suffix:
Gender:F
Credentials:RN, IBCLC
Other - Prefix:
Other - First Name:SUSAN
Other - Middle Name:KIMLIN
Other - Last Name:MCDANIEL
Other - Suffix:JR
Other - Last Name Type:Former Name
Other - Credentials:RN, IBCLC
Mailing Address - Street 1:1400 EMELINE AVE
Mailing Address - Street 2:
Mailing Address - City:SANTA CRUZ
Mailing Address - State:CA
Mailing Address - Zip Code:95060-1976
Mailing Address - Country:US
Mailing Address - Phone:831-454-4857
Mailing Address - Fax:831-454-5049
Practice Address - Street 1:1400 EMELINE AVE
Practice Address - Street 2:
Practice Address - City:SANTA CRUZ
Practice Address - State:CA
Practice Address - Zip Code:95060-1976
Practice Address - Country:US
Practice Address - Phone:831-454-4857
Practice Address - Fax:831-454-5049
Is Sole Proprietor?:No
Enumeration Date:2011-10-03
Last Update Date:2011-10-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA418307163WP1700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163WP1700XNursing Service ProvidersRegistered NursePerinatal
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA418307OtherRN LICENSE