Healthcare Provider Details

I. General information

NPI: 1104066372
Provider Name (Legal Business Name): KIMBERLY E MARTIN RN
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: KIMBERLY E DUFFEY RN

II. Dates (important events)

Enumeration Date: 03/02/2009
Last Update Date: 03/02/2009
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5837 HAMILTON AVE
CINCINNATI OH
45224-2923
US

IV. Provider business mailing address

2600 VICTORY PKWY
CINCINNATI OH
45206-1711
US

V. Phone/Fax

Practice location:
  • Phone: 513-547-7577
  • Fax: 513-541-5895
Mailing address:
  • Phone: 513-872-5863
  • Fax: 513-872-5182

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code163W00000X
TaxonomyRegistered Nurse
License NumberRN 289033
License Number StateOH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: