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General NPI Number Information
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NPI Number | 1922390749
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Entity Type | Organization
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Legal Business Name | MAUREEN G HOLMGREN NIMMO
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Dates
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Enumeration Date | 05/12/2011
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Last Update Date | 07/18/2011
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Provider Practice Location Address
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Address Line | 867 DARNELL RD
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City | BENTON
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State | KY
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Zip | 42025-6903
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Country | US
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Telephone | 270-205-6624
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Fax | 270-933-4031
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Provider Business Mailing Address
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Address Line | 867 DARNELL RD
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City | BENTON
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State | KY
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Zip | 42025-6903
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Country | US
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Telephone | 270-205-6624
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Fax | 270-933-4031
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Authorized Official
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Title or Position | OWNER
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Name | MAUREEN G NIMMO
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Credential |
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Telephone | 270-205-6624
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 372600000X
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Taxonomy Name | Adult Companion
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License Number | 500128
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License Number State | KY
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