1952554289 NPI number — KIMBERLI LOUISE CARROLL MSN, NNP

Table of content: KIMBERLI LOUISE CARROLL MSN, NNP (NPI 1952554289)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1952554289 NPI number — KIMBERLI LOUISE CARROLL MSN, NNP

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
CARROLL
Provider First Name:
KIMBERLI
Provider Middle Name:
LOUISE
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
MSN, NNP
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1952554289
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
11/30/2021
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
3301 W FOREST HOME AVE
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
MILWAUKEE
Provider Business Mailing Address State Name:
WI
Provider Business Mailing Address Postal Code:
53215-2843
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
414-389-2152
Provider Business Mailing Address Fax Number:

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
975 PORT WASHINGTON RD
Provider Second Line Business Practice Location Address:
NICU
Provider Business Practice Location Address City Name:
GRAFTON
Provider Business Practice Location Address State Name:
WI
Provider Business Practice Location Address Postal Code:
53024-9201
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
262-329-4900
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
10/30/2008

Additional Information

			
		

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 363LN0000X , with the licence number:  130979-030 , registered in the state of WI ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 363LN0000X , with the licence number: 1896-33 , registered in the state of WI ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 363L00000X , with the licence number: 1896-33 , registered in the state of WI ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)

  • Identifier: 100026057 , issued by the state of ( WI ) . This identifiers is of the category "MEDICAID".