Healthcare Provider Details

I. General information

NPI: 1750747606
Provider Name (Legal Business Name): KIMBERLY ANN KUIECK RN
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

Provider Other Name: KIMBERLY ANN DEAL

II. Dates (important events)

Enumeration Date: 01/07/2016
Last Update Date: 01/12/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3928 N TOWNSHIP ROAD 175
REPUBLIC OH
44867-9711
US

IV. Provider business mailing address

3928 N TOWNSHIP ROAD 175
REPUBLIC OH
44867-9711
US

V. Phone/Fax

Practice location:
  • Phone: 419-307-6867
  • Fax:
Mailing address:
  • Phone: 419-307-6867
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code163W00000X
TaxonomyRegistered Nurse
License NumberRN.341774
License Number StateOH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: