MEDICARE: MRS. KIMBERLY ANN SHMINA NP

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	363LF0000X	Family Nurse Practitioner	4704169463	MI

General Provider Information

NPI Number	:	1598810251
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MRS. KIMBERLY ANN SHMINA NP

Provider Business Mailing Address
First Line	:	7911 BOUVIER BAY RD
Second Line	:
City	:	IRA
State	:	MI
Zip	:	48023-2739
Country	:	US
Telephone Number	:	586-726-6318
Fax Number	:

Provider Business Practice Location Address
First Line	:	7911 BOUVIER BAY RD
Second Line	:
City	:	IRA
State	:	MI
Zip	:	48023-2739
Country	:	US
Telephone Number	:	586-726-6318
Fax Number	:

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

Provider Enumeration Date	:	01/24/2007
Last Update Date	:	07/08/2007

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