Healthcare Provider Details

I. General information

NPI: 1659992063
Provider Name (Legal Business Name): KIMBERLY WILLIS FIELD RN
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 04/27/2020
Last Update Date: 04/27/2020
Certification Date: 04/27/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3124 S 19TH ST STE 200
TACOMA WA
98405-2433
US

IV. Provider business mailing address

PO BOX 2237
SHELTON WA
98584-5052
US

V. Phone/Fax

Practice location:
  • Phone: 253-792-6166
  • Fax: 253-459-6165
Mailing address:
  • Phone: 360-490-8703
  • Fax: 253-459-6165

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code163WP2201X
TaxonomyAmbulatory Care Registered Nurse
License Number00074898
License Number StateWA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: