Provider Demographics
NPI:1447085626
Name:PETERMANN, KIM LAINA (MSN, RN, IBCLC)
Entity type:Individual
Prefix:
First Name:KIM LAINA
Middle Name:
Last Name:PETERMANN
Suffix:
Gender:F
Credentials:MSN, RN, IBCLC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2745 EVERGREEN CIR
Mailing Address - Street 2:
Mailing Address - City:EMMAUS
Mailing Address - State:PA
Mailing Address - Zip Code:18049-1206
Mailing Address - Country:US
Mailing Address - Phone:860-307-0891
Mailing Address - Fax:
Practice Address - Street 1:2745 EVERGREEN CIR
Practice Address - Street 2:
Practice Address - City:EMMAUS
Practice Address - State:PA
Practice Address - Zip Code:18049-1206
Practice Address - Country:US
Practice Address - Phone:860-307-0891
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-09-05
Last Update Date:2024-09-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PARN712986163WL0100X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163WL0100XNursing Service ProvidersRegistered NurseLactation Consultant