Provider Demographics
NPI:1114276557
Name:SANDS, KIMBERLEY ANN (RN)
Entity Type:Individual
Prefix:MRS
First Name:KIMBERLEY
Middle Name:ANN
Last Name:SANDS
Suffix:
Gender:F
Credentials:RN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6330 W. THUNDERBIRD ROAD
Mailing Address - Street 2:
Mailing Address - City:GLENDALE
Mailing Address - State:AZ
Mailing Address - Zip Code:85306-4002
Mailing Address - Country:US
Mailing Address - Phone:623-487-5189
Mailing Address - Fax:
Practice Address - Street 1:6330 W. THUNDERBIRD ROAD
Practice Address - Street 2:
Practice Address - City:GLENDALE
Practice Address - State:AZ
Practice Address - Zip Code:85306-4002
Practice Address - Country:US
Practice Address - Phone:623-487-5189
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2012-08-30
Last Update Date:2012-08-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZRN095177163WS0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163WS0200XNursing Service ProvidersRegistered NurseSchool