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General NPI Number Information
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NPI Number | 1720117658
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Entity Type | Individual
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Provider Name | KIMBERLY SUE MCWILLIAMS STATE TESTED NURSES
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Gender | Female
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Dates
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Enumeration Date | 03/05/2007
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Last Update Date | 07/08/2007
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Provider Practice Location Address
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Address Line | 1406 MAXWELL AVE NW APT# B
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City | WARREN
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State | OH
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Zip | 44485-2130
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Country | US
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Telephone | 330-555-9589
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Fax |
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Provider Business Mailing Address
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Address Line | 1360 DREXEL AVE NW
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City | WARREN
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State | OH
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Zip | 44485-2112
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Country | US
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Telephone | 330-392-0359
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 374U00000X
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Taxonomy Name | Home Health Aide
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License Number |
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License Number State |
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