MEDICARE: KIMBERLY HOLLINGER R.N.

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	163W00000X	Registered Nurse	RN.167423-	OH

General Provider Information

NPI Number	:	1750791851
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	KIMBERLY HOLLINGER R.N.

Provider Business Mailing Address
First Line	:	12687 BASS LAKE RD
Second Line	:
City	:	CHARDON
State	:	OH
Zip	:	44024-8316
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	12687 BASS LAKE RD
Second Line	:
City	:	CHARDON
State	:	OH
Zip	:	44024-8316
Country	:	US
Telephone Number	:	440-286-5901
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	04/29/2014
Last Update Date	:	04/29/2014

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