Provider Demographics
NPI:1093208183
Name:RODRIGUEZ, KIMBERLY S
Entity Type:Individual
Prefix:MRS
First Name:KIMBERLY
Middle Name:S
Last Name:RODRIGUEZ
Suffix:
Gender:F
Credentials:
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 42
Mailing Address - Street 2:550 WHITE HAVEN RD
Mailing Address - City:BEAR CREEK
Mailing Address - State:PA
Mailing Address - Zip Code:18602
Mailing Address - Country:US
Mailing Address - Phone:989-351-8833
Mailing Address - Fax:
Practice Address - Street 1:550 WHITE HAVEN RD
Practice Address - Street 2:
Practice Address - City:BEAR CREEK
Practice Address - State:PA
Practice Address - Zip Code:18602
Practice Address - Country:US
Practice Address - Phone:989-351-8833
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2018-06-13
Last Update Date:2018-06-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes176B00000XOther Service ProvidersMidwife