Provider Demographics
NPI:1013218023
Name:ACKERMAN, KIMBERLY DIANE (RN,BSN)
Entity Type:Individual
Prefix:
First Name:KIMBERLY
Middle Name:DIANE
Last Name:ACKERMAN
Suffix:
Gender:F
Credentials:RN,BSN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1600 PENINSULA DR
Mailing Address - Street 2:SUITE 19
Mailing Address - City:ERIE
Mailing Address - State:PA
Mailing Address - Zip Code:16505-4261
Mailing Address - Country:US
Mailing Address - Phone:814-833-0221
Mailing Address - Fax:814-833-3346
Practice Address - Street 1:1600 PENINSULA DR
Practice Address - Street 2:SUITE 19
Practice Address - City:ERIE
Practice Address - State:PA
Practice Address - Zip Code:16505-4261
Practice Address - Country:US
Practice Address - Phone:814-833-0221
Practice Address - Fax:814-833-3346
Is Sole Proprietor?:Yes
Enumeration Date:2010-11-07
Last Update Date:2010-11-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PARN505100L163WA2000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163WA2000XNursing Service ProvidersRegistered NurseAdministrator