Healthcare Provider Details

I. General information

NPI: 1386565521
Provider Name (Legal Business Name): KIMBERLY MICHELLE DETWEILER BSN, RN
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: KIMBERLY MICHELLE MOWERY BSN, RN

II. Dates (important events)

Enumeration Date: 07/23/2026
Last Update Date: 07/23/2026
Certification Date: 07/23/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

555 N DUKE ST
LANCASTER PA
17602-2250
US

IV. Provider business mailing address

922 EDGEWOOD AVE
LANCASTER PA
17603-4809
US

V. Phone/Fax

Practice location:
  • Phone: 717-544-5511
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code163WX0800X
TaxonomyOrthopedic Registered Nurse
License NumberRN759253
License Number StatePA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: