Provider Demographics
NPI:1043238686
Name:SAMBORN-JUROVIESKY, KIMBERLY (ARNP-CNM)
Entity Type:Individual
Prefix:MRS
First Name:KIMBERLY
Middle Name:
Last Name:SAMBORN-JUROVIESKY
Suffix:
Gender:F
Credentials:ARNP-CNM
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:C/O CHARLES A PERKINS JR, MEDICAL CREDENTIALS ASST.
Mailing Address - Street 2:375MDG/SGHQ
Mailing Address - City:SCOTT AFB
Mailing Address - State:IL
Mailing Address - Zip Code:62225-5252
Mailing Address - Country:US
Mailing Address - Phone:618-256-7600
Mailing Address - Fax:
Practice Address - Street 1:C/O CHARLES A PERKINS JR, MEDICAL CREDENTIALS ASST.
Practice Address - Street 2:375MDG/SGHQ
Practice Address - City:SCOTT AFB
Practice Address - State:IL
Practice Address - Zip Code:62225-5252
Practice Address - Country:US
Practice Address - Phone:618-256-7600
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-07-18
Last Update Date:2007-07-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLARNP 9180037367A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes367A00000XPhysician Assistants & Advanced Practice Nursing ProvidersAdvanced Practice Midwife