Healthcare Provider Details

I. General information

NPI: 1386614584
Provider Name (Legal Business Name): KIMBERLY J MINER ND, CNS, CWCN
Entity Type: Individual
Gender: Female
Sole Proprietor: X

II. Dates (important events)

Enumeration Date: 01/23/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

888 W ITHACA AVE
ENGLEWOOD CO
80110-3468
US

IV. Provider business mailing address

7399 S SYRACUSE CT
CENTENNIAL CO
80112-1749
US

V. Phone/Fax

Practice location:
  • Phone: 303-789-2777
  • Fax: 303-789-2556
Mailing address:
  • Phone: 303-789-2777
  • Fax: 303-789-2556

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code364S00000X
TaxonomyClinical Nurse Specialist
License Number1040
License Number StateCO

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: