Healthcare Provider Details

I. General information

NPI: 1932084753
Provider Name (Legal Business Name): KIMBERLY NUNWEILER
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/11/2025
Last Update Date: 08/11/2025
Certification Date: 08/10/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6722 FAIR OAKS BLVD
CARMICHAEL CA
95608-3812
US

IV. Provider business mailing address

740 FIFTEEN MILE DR
ROSEVILLE CA
95678-5926
US

V. Phone/Fax

Practice location:
  • Phone: 724-570-9111
  • Fax:
Mailing address:
  • Phone: 724-570-9111
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: