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NPI Code Detail

MEDICARE: KIMBERLY DAWN ROOD CPNP

MEDICARE: KIMBERLY DAWN ROOD CPNP
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
1363LP0200XPediatric Nurse Practitioner4704162094MI

Other Identifiers

# Provider Identifier Provider Identifier Type Provider Identifier State Provider Identifier Issuer
15008601810OTHERMIBLUE CROSS/BLUE SHIELD
2MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number : 1033106224
Entity Type Code : Individual
Provider Name (Legal Business Name) : KIMBERLY DAWN ROOD CPNP
Provider Business Mailing Address
First Line : 3901 BEAUBIEN ST
Second Line :
City : DETROIT
State : MI
Zip : 48201-2119
Country : US
Telephone Number : 313-745-5750
Fax Number : 313-831-3908
Provider Business Practice Location Address
First Line : 3901 BEAUBIEN ST
Second Line :
City : DETROIT
State : MI
Zip : 48201-2119
Country : US
Telephone Number : 313-745-5750
Fax Number : 313-831-3908
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 10/03/2005
Last Update Date : 02/09/2012

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Directions to “ KIMBERLY DAWN ROOD CPNP” Practice Location

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