Healthcare Provider Details

I. General information

NPI: 1730838616
Provider Name (Legal Business Name): KIMBERLY DIGEROLAMO RN, CNS
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 03/20/2022
Last Update Date: 03/20/2022
Certification Date: 03/20/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3401 CIVIC CENTER BLVD
PHILADELPHIA PA
19104-4319
US

IV. Provider business mailing address

309 WINDING WAY
HAMMONTON NJ
08037-2210
US

V. Phone/Fax

Practice location:
  • Phone: 215-590-7014
  • Fax:
Mailing address:
  • Phone: 267-977-4282
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code364SP0200X
TaxonomyPediatric Clinical Nurse Specialist
License NumberCNS000154
License Number StatePA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: