Healthcare Provider Details

I. General information

NPI: 1871541342
Provider Name (Legal Business Name): KIMBERLY WILLIAMS NP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: KIMBERLY BERG NP

II. Dates (important events)

Enumeration Date: 05/05/2006
Last Update Date: 12/02/2025
Certification Date: 12/02/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1650 S 41ST ST
MANITOWOC WI
54220-7316
US

IV. Provider business mailing address

1650 S 41ST ST
MANITOWOC WI
54220-7316
US

V. Phone/Fax

Practice location:
  • Phone: 920-320-5241
  • Fax: 920-320-5178
Mailing address:
  • Phone: 920-320-5241
  • Fax: 920-320-5178

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code363L00000X
TaxonomyNurse Practitioner
License Number11987
License Number StateWI
# 2
Primary TaxonomyY
Taxonomy Code363L00000X
TaxonomyNurse Practitioner
License Number2155-33
License Number StateWI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: