Healthcare Provider Details

I. General information

NPI: 1215189501
Provider Name (Legal Business Name): KIMBERLY MARIE PATRICK ADN-RN
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 10/17/2008
Last Update Date: 03/29/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

608 WRIGHT AVE
ALMA MI
48801-1600
US

IV. Provider business mailing address

PO BOX 69 608 WRIGHT AVE.
ALMA MI
48801-0069
US

V. Phone/Fax

Practice location:
  • Phone: 989-463-4971
  • Fax: 989-463-6515
Mailing address:
  • Phone: 989-463-4971
  • Fax: 989-463-6515

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code163W00000X
TaxonomyRegistered Nurse
License Number4704222756
License Number StateMI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: