Healthcare Provider Details

I. General information

NPI: 1437471364
Provider Name (Legal Business Name): KIMBERLY DAWN HEUBACH RN
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 02/19/2010
Last Update Date: 02/19/2010
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

12575 CADEK RD
HIRAM OH
44234-9716
US

IV. Provider business mailing address

12575 CADEK RD
HIRAM OH
44234-9716
US

V. Phone/Fax

Practice location:
  • Phone: 330-569-7424
  • Fax:
Mailing address:
  • Phone: 330-569-7424
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code163W00000X
TaxonomyRegistered Nurse
License Number222624
License Number StateOH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: