Healthcare Provider Details

I. General information

NPI: 1902280134
Provider Name (Legal Business Name): KIMBERLY VRIEZELAAR FNP-C
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/17/2015
Last Update Date: 10/12/2024
Certification Date: 10/12/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2222 CHERRY ST SUITE M800
TOLEDO OH
43608-2673
US

IV. Provider business mailing address

2200 JEFFERSON AVE 5TH FLOOR
TOLEDO OH
43604-7101
US

V. Phone/Fax

Practice location:
  • Phone: 419-251-3292
  • Fax: 419-251-7821
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License NumberAPRN.CNP.17664
License Number StateOH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: