Healthcare Provider Details

I. General information

NPI: 1811995228
Provider Name (Legal Business Name): KIMBERLY KAY FENBERT DNP, CPNP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: KIMBERLY KAY BLEICH CPNP - RN

II. Dates (important events)

Enumeration Date: 07/09/2005
Last Update Date: 02/26/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

684 HARVEY ST STE 201
MUSKEGON MI
49442-4274
US

IV. Provider business mailing address

684 HARVEY ST STE 201
MUSKEGON MI
49442-4274
US

V. Phone/Fax

Practice location:
  • Phone: 231-773-7837
  • Fax: 231-773-7943
Mailing address:
  • Phone: 231-773-7837
  • Fax: 231-773-7943

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LP0200X
TaxonomyPediatric Nurse Practitioner
License Number4704137456
License Number StateMI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: