Healthcare Provider Details

I. General information

NPI: 1356790844
Provider Name (Legal Business Name): KIMBERLY CAIN BSN, RN, IBCLC
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 06/06/2016
Last Update Date: 06/06/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

27 SAINT GERMAIN PL
SAINT CHARLES IL
60175-4608
US

IV. Provider business mailing address

27 SAINT GERMAIN PL
SAINT CHARLES IL
60175-4608
US

V. Phone/Fax

Practice location:
  • Phone: 630-254-5515
  • Fax:
Mailing address:
  • Phone: 630-254-5515
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code163W00000X
TaxonomyRegistered Nurse
License Number041.286326
License Number StateIL
# 2
Primary TaxonomyY
Taxonomy Code163WL0100X
TaxonomyLactation Consultant (Registered Nurse)
License Number10726048
License Number StateIL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: