Provider Demographics
NPI:1043641509
Name:YORMARK, KIMBERLY (MS, AGACNP)
Entity Type:Individual
Prefix:MRS
First Name:KIMBERLY
Middle Name:
Last Name:YORMARK
Suffix:
Gender:F
Credentials:MS, AGACNP
Other - Prefix:
Other - First Name:KIMBERLY
Other - Middle Name:
Other - Last Name:VIAL
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MS, AGACNP
Mailing Address - Street 1:111 E CHESTNUT ST
Mailing Address - Street 2:UNIT 44F
Mailing Address - City:CHICAGO
Mailing Address - State:IL
Mailing Address - Zip Code:60611-2051
Mailing Address - Country:US
Mailing Address - Phone:262-751-7692
Mailing Address - Fax:
Practice Address - Street 1:1801 W TAYLOR ST
Practice Address - Street 2:
Practice Address - City:CHICAGO
Practice Address - State:IL
Practice Address - Zip Code:60612-4795
Practice Address - Country:US
Practice Address - Phone:866-600-2273
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2013-12-10
Last Update Date:2013-12-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL209010822363LA2100X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LA2100XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerAcute Care