Healthcare Provider Details

I. General information

NPI: 1255257010
Provider Name (Legal Business Name): ELIZABETH MARIE KIMBALL FNP-BC
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/26/2026
Last Update Date: 06/26/2026
Certification Date: 06/15/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

100 WASHINGTON AVE S STE 1210
MINNEAPOLIS MN
55401-2104
US

IV. Provider business mailing address

139 THROWER RD
ATHOL MA
01331-9549
US

V. Phone/Fax

Practice location:
  • Phone: 978-434-1485
  • Fax:
Mailing address:
  • Phone: 978-434-1485
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code163W00000X
TaxonomyRegistered Nurse
License NumberRN2367144
License Number StateMA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: