Healthcare Provider Details

I. General information

NPI: 1013086370
Provider Name (Legal Business Name): MRS. KIMBERLY ANN ROSENBAUM
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 11/08/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

MARTIN ARMY COMMUNITY HOSPITAL BLDG 9200
FT BENNING GA
31905
US

IV. Provider business mailing address

103 DUBLINSKY ST
FORT BENNING GA
31905-6902
US

V. Phone/Fax

Practice location:
  • Phone: 706-544-2802
  • Fax:
Mailing address:
  • Phone: 706-610-8812
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code163WM0102X
TaxonomyMaternal Newborn Registered Nurse
License Number54669
License Number StateHI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: