Healthcare Provider Details

I. General information

NPI: 1861489189
Provider Name (Legal Business Name): KIMBERLY A WESTRA CRNA
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/03/2005
Last Update Date: 11/02/2023
Certification Date: 11/02/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

640 S STATE ST
DOVER DE
19901-3530
US

IV. Provider business mailing address

14119 SEA CAPTAIN RD
OCEAN CITY MD
21842-5637
US

V. Phone/Fax

Practice location:
  • Phone: 302-674-4700
  • Fax: 302-744-6407
Mailing address:
  • Phone: 215-917-6678
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code163W00000X
TaxonomyRegistered Nurse
License NumberRN354673L
License Number StatePA
# 2
Primary TaxonomyN
Taxonomy Code367500000X
TaxonomyCertified Registered Nurse Anesthetist
License Number053594
License Number StatePA
# 3
Primary TaxonomyN
Taxonomy Code367500000X
TaxonomyCertified Registered Nurse Anesthetist
License NumberL6-0A00820
License Number StateDE
# 4
Primary TaxonomyY
Taxonomy Code367500000X
TaxonomyCertified Registered Nurse Anesthetist
License Number0024183064
License Number StateVA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: