Healthcare Provider Details

I. General information

NPI: 1578868451
Provider Name (Legal Business Name): KIMBERLY N. DELAY CPM, LM
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 01/24/2011
Last Update Date: 09/19/2024
Certification Date: 09/19/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

33511 S LAKESHORE DR
BURLINGTON WI
53105-9292
US

IV. Provider business mailing address

33511 S LAKESHORE DR
BURLINGTON WI
53105-9292
US

V. Phone/Fax

Practice location:
  • Phone: 262-977-3070
  • Fax: 262-458-4105
Mailing address:
  • Phone: 262-977-3070
  • Fax: 262-458-4105

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code176B00000X
TaxonomyMidwife
License Number48-49
License Number StateWI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: