MEDICARE: MS. KIMBERLY J. NEDROW LMP BCTMB CST-D

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
1	174400000X	Specialist	MA00014338	WA

General Provider Information

NPI Number	:	1063590008
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MS. KIMBERLY J. NEDROW LMP BCTMB CST-D

Provider Business Mailing Address
First Line	:	221 KENYON ST NW STE 103
Second Line	:
City	:	OLYMPIA
State	:	WA
Zip	:	98502-4581
Country	:	US
Telephone Number	:	360-956-3771
Fax Number	:	360-352-5855

Provider Business Practice Location Address
First Line	:	221 KENYON ST NW STE 103
Second Line	:
City	:	OLYMPIA
State	:	WA
Zip	:	98502-4581
Country	:	US
Telephone Number	:	360-705-1133
Fax Number	:	360-352-5855

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	11/01/2006
Last Update Date	:	01/30/2024

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Directions to “ MS. KIMBERLY J. NEDROW LMP BCTMB CST-D” Practice Location

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