Provider Demographics
NPI:1043547466
Name:KIMMET, ANNA MARIA (STNA)
Entity Type:Individual
Prefix:MRS
First Name:ANNA
Middle Name:MARIA
Last Name:KIMMET
Suffix:
Gender:F
Credentials:STNA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:265 S MEACHEN GROVE RD
Mailing Address - Street 2:LOT 53
Mailing Address - City:PORT CLINTON
Mailing Address - State:OH
Mailing Address - Zip Code:43452
Mailing Address - Country:US
Mailing Address - Phone:419-603-0470
Mailing Address - Fax:
Practice Address - Street 1:265 S MEACHEM RD
Practice Address - Street 2:LOT 53
Practice Address - City:PORT CLINTON
Practice Address - State:OH
Practice Address - Zip Code:43452-9243
Practice Address - Country:US
Practice Address - Phone:419-603-0470
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2009-11-05
Last Update Date:2009-11-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH372955890493376K00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes376K00000XNursing Service Related ProvidersNurse's Aide