Healthcare Provider Details

I. General information

NPI: 1043938715
Provider Name (Legal Business Name): KIMBERLEY HOGLUND RN
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

Provider Other Name: KIMBERLEY MYERS RN

II. Dates (important events)

Enumeration Date: 08/18/2022
Last Update Date: 08/18/2022
Certification Date: 08/18/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2515 MATHEWS ST
BERKELEY CA
94702-2008
US

IV. Provider business mailing address

2515 MATHEWS ST
BERKELEY CA
94702-2008
US

V. Phone/Fax

Practice location:
  • Phone: 510-504-8514
  • Fax:
Mailing address:
  • Phone: 510-504-8514
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code163W00000X
TaxonomyRegistered Nurse
License NumberRN532762
License Number StateCA
# 2
Primary TaxonomyN
Taxonomy Code163WC0400X
TaxonomyCase Management Registered Nurse
License NumberRN532761
License Number StateCA
# 3
Primary TaxonomyN
Taxonomy Code163WC1600X
TaxonomyContinuing Education/Staff Development Registered Nurse
License NumberRN532761
License Number StateCA
# 4
Primary TaxonomyN
Taxonomy Code163WG0000X
TaxonomyGeneral Practice Registered Nurse
License NumberRN531761
License Number StateCA
# 5
Primary TaxonomyN
Taxonomy Code163WH0200X
TaxonomyHome Health Registered Nurse
License NumberRN532761
License Number StateCA
# 6
Primary TaxonomyN
Taxonomy Code163WM1400X
TaxonomyNurse Massage Therapist (NMT)
License NumberRN532761
License Number StateCA
# 7
Primary TaxonomyN
Taxonomy Code163WN1003X
TaxonomyNutrition Support Registered Nurse
License NumberRN532761
License Number StateCA
# 8
Primary TaxonomyN
Taxonomy Code163WP0000X
TaxonomyPain Management Registered Nurse
License NumberRN532761
License Number StateCA
# 9
Primary TaxonomyY
Taxonomy Code163WA2000X
TaxonomyAdministrator Registered Nurse
License NumberRN5312761
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: