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NPI Code Detail

MEDICARE: MRS. KIMBERLY TAI WISE DEM

MEDICARE: MRS. KIMBERLY TAI WISE DEM
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
1176B00000XMidwife

General Provider Information

NPI Number : 1134411788
Entity Type Code : Individual
Provider Name (Legal Business Name) : MRS. KIMBERLY TAI WISE DEM
Provider Business Mailing Address
First Line : 966 CLEVELAND ST
Second Line :
City : LEBANON
State : OR
Zip : 97355-4422
Country : US
Telephone Number : 541-401-1667
Fax Number :
Provider Business Practice Location Address
First Line : 966 CLEVELAND ST
Second Line :
City : LEBANON
State : OR
Zip : 97355-4422
Country : US
Telephone Number : 541-401-1667
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 05/13/2011
Last Update Date : 05/13/2011

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Directions to “ MRS. KIMBERLY TAI WISE DEM” Practice Location

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