MEDICARE: MRS. KIMBERLY ELLEN DUBOIS R.N.

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	163WE0003X	Emergency Registered Nurse	55912	HI
2	163WE0003X	Emergency Registered Nurse		IL

General Provider Information

NPI Number	:	1609093244
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MRS. KIMBERLY ELLEN DUBOIS R.N.

Provider Business Mailing Address
First Line	:	47-291 HUI IWA ST
Second Line	:	UNIT C
City	:	KANEOHE
State	:	HI
Zip	:	96744-4330
Country	:	US
Telephone Number	:	808-590-1728
Fax Number	:

Provider Business Practice Location Address
First Line	:	BLDG.1407- MAKALAPA ROAD
Second Line	:
City	:	PEARL HARBOR
State	:	HI
Zip	:	96814-3610
Country	:	US
Telephone Number	:	808-473-0247
Fax Number	:

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

Provider Enumeration Date	:	04/18/2007
Last Update Date	:	07/08/2007

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