Healthcare Provider Details

I. General information

NPI: 1447432240
Provider Name (Legal Business Name): KIMBERLY K DIMINO NNP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 12/04/2007
Last Update Date: 05/14/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1 PERKINS SQ
AKRON OH
44308-1063
US

IV. Provider business mailing address

5547 STONECREEK WAY
HUDSON OH
44236-4191
US

V. Phone/Fax

Practice location:
  • Phone: 330-543-8352
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LN0005X
TaxonomyCritical Care Neonatal Nurse Practitioner
License Number363110-4405
License Number StateUT

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: