Provider Demographics
NPI:1164932240
Name:RIEBSOMER, KIMBERLY SHERAH
Entity Type:Individual
Prefix:
First Name:KIMBERLY
Middle Name:SHERAH
Last Name:RIEBSOMER
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 28628
Mailing Address - Street 2:
Mailing Address - City:SANTA FE
Mailing Address - State:NM
Mailing Address - Zip Code:87592-8628
Mailing Address - Country:US
Mailing Address - Phone:505-310-9069
Mailing Address - Fax:505-780-5529
Practice Address - Street 1:2916 GOVERNOR MABRY CT
Practice Address - Street 2:
Practice Address - City:SANTA FE
Practice Address - State:NM
Practice Address - Zip Code:87505-6438
Practice Address - Country:US
Practice Address - Phone:505-310-9069
Practice Address - Fax:505-780-5529
Is Sole Proprietor?:Yes
Enumeration Date:2017-10-03
Last Update Date:2017-10-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251B00000XAgenciesCase Management