Healthcare Provider Details

I. General information

NPI: 1316910029
Provider Name (Legal Business Name): KIMBERLY GESELBRACHT RN
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 02/12/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5416 MONTGOMERY RD
CINCINNATI OH
45212-1707
US

IV. Provider business mailing address

5416 MONTGOMERY RD
CINCINNATI OH
45212-1707
US

V. Phone/Fax

Practice location:
  • Phone: 513-238-3791
  • Fax: 513-631-0601
Mailing address:
  • Phone: 513-238-3791
  • Fax: 513-631-0601

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code163WH0200X
TaxonomyHome Health Registered Nurse
License Number254374
License Number StateOH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: