Healthcare Provider Details

I. General information

NPI: 1609730597
Provider Name (Legal Business Name): KIMBERLY ELLEN DEMIRHAN RN
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 12/15/2025
Last Update Date: 12/15/2025
Certification Date: 12/15/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

9528 BLACKBURN DR
BURKE VA
22015-1714
US

IV. Provider business mailing address

9528 BLACKBURN DR
BURKE VA
22015-1714
US

V. Phone/Fax

Practice location:
  • Phone: 610-417-9936
  • Fax:
Mailing address:
  • Phone: 610-417-9936
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code173000000X
TaxonomyLegal Medicine
License NumberRN1043805
License Number StateDC

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: