Provider Demographics
NPI:1083834907
Name:RADER, KIMBERLY PRINCESS (LPN)
Entity Type:Individual
Prefix:
First Name:KIMBERLY
Middle Name:PRINCESS
Last Name:RADER
Suffix:
Gender:F
Credentials:LPN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 232
Mailing Address - Street 2:
Mailing Address - City:DADE CITY
Mailing Address - State:FL
Mailing Address - Zip Code:33526
Mailing Address - Country:US
Mailing Address - Phone:352-518-2000
Mailing Address - Fax:352-567-5193
Practice Address - Street 1:37944 CHURCH AVE
Practice Address - Street 2:
Practice Address - City:DADE CITY
Practice Address - State:FL
Practice Address - Zip Code:33525
Practice Address - Country:US
Practice Address - Phone:352-518-2000
Practice Address - Fax:352-567-5193
Is Sole Proprietor?:No
Enumeration Date:2007-04-26
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLPN1059411164W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes164W00000XNursing Service ProvidersLicensed Practical Nurse