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NPI Code Detail

MEDICARE: KIMBERLY DEMAYO RN

MEDICARE: KIMBERLY DEMAYO RN
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
1163W00000XRegistered Nurse041321551IL

General Provider Information

NPI Number : 1093487266
Entity Type Code : Individual
Provider Name (Legal Business Name) : KIMBERLY DEMAYO RN
Provider Business Mailing Address
First Line : 321 ARNOLD AVE
Second Line :
City : ROCKFORD
State : IL
Zip : 61108-2315
Country : US
Telephone Number : 815-397-5531
Fax Number :
Provider Business Practice Location Address
First Line : 321 ARNOLD AVE
Second Line :
City : ROCKFORD
State : IL
Zip : 61108-2315
Country : US
Telephone Number : 815-397-5531
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 10/05/2021
Last Update Date : 10/05/2021

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