Healthcare Provider Details

I. General information

NPI: 1306375050
Provider Name (Legal Business Name): KIMBERLY EVE JUSTICE RN
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

Provider Other Name: KIMBERLY EVE SHILLING

II. Dates (important events)

Enumeration Date: 06/07/2017
Last Update Date: 06/07/2017
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

401 TUSCARAWAS ST W STE 501
CANTON OH
44702-2045
US

IV. Provider business mailing address

434 EASTLAND RD
BEREA OH
44017-1217
US

V. Phone/Fax

Practice location:
  • Phone: 440-260-6466
  • Fax: 330-438-1748
Mailing address:
  • Phone: 440-260-8327
  • Fax: 440-234-8319

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code163WC1500X
TaxonomyCommunity Health Registered Nurse
License Number333839
License Number StateOH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: