Healthcare Provider Details

I. General information

NPI: 1134948250
Provider Name (Legal Business Name): KIM ROSE ZIBBELL BS, CHW, LS
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 10/07/2024
Last Update Date: 10/07/2024
Certification Date: 10/07/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

700 FULLER AVE NE
GRAND RAPIDS MI
49503-1918
US

IV. Provider business mailing address

700 FULLER AVE NE
GRAND RAPIDS MI
49503-1918
US

V. Phone/Fax

Practice location:
  • Phone: 616-690-1975
  • Fax:
Mailing address:
  • Phone: 616-690-1975
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code172V00000X
TaxonomyCommunity Health Worker
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: