Healthcare Provider Details

I. General information

NPI: 1417364936
Provider Name (Legal Business Name): KIMBERLY NAVRATIL
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/16/2014
Last Update Date: 03/21/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

112 INDEPENDENCE WAY SUITE 110
CLYDE OH
43410-9811
US

IV. Provider business mailing address

PO BOX 378
SANDUSKY OH
44871-0378
US

V. Phone/Fax

Practice location:
  • Phone: 419-483-9000
  • Fax: 419-483-9003
Mailing address:
  • Phone: 419-609-1112
  • Fax: 419-609-1123

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code364SA2200X
TaxonomyAdult Health Clinical Nurse Specialist
License NumberCOA.12352NS
License Number StateOH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: