Healthcare Provider Details

I. General information

NPI: 1588047021
Provider Name (Legal Business Name): KIMBERLEE KAY BORNEMAN C.N.M.
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 07/01/2015
Last Update Date: 03/18/2025
Certification Date: 03/18/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

146 W DALE ST SUITE 102
WATERLOO IA
50703-1901
US

IV. Provider business mailing address

5002 WILLOWBEND RD NE
CEDAR RAPIDS IA
52411-6513
US

V. Phone/Fax

Practice location:
  • Phone: 319-235-5050
  • Fax: 319-235-5107
Mailing address:
  • Phone: 319-431-7867
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code367A00000X
TaxonomyAdvanced Practice Midwife
License NumberB109170
License Number StateIA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: