Healthcare Provider Details

I. General information

NPI: 1750142394
Provider Name (Legal Business Name): KIMBERLY PIPAL REGISTERED NURSE
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 01/22/2024
Last Update Date: 01/22/2024
Certification Date: 01/20/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2605 WINCHESTER BLVD
CAMPBELL CA
95008-5320
US

IV. Provider business mailing address

1152 EL ABRA WAY
SAN JOSE CA
95125-3112
US

V. Phone/Fax

Practice location:
  • Phone: 408-402-0663
  • Fax:
Mailing address:
  • Phone: 209-844-9210
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code163WP2201X
TaxonomyAmbulatory Care Registered Nurse
License Number674056
License Number StateCA
# 2
Primary TaxonomyY
Taxonomy Code163WE0003X
TaxonomyEmergency Registered Nurse
License Number674056
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: