Provider Demographics
NPI:1245606946
Name:DONALD, KIMBERLEY (APN)
Entity Type:Individual
Prefix:
First Name:KIMBERLEY
Middle Name:
Last Name:DONALD
Suffix:
Gender:F
Credentials:APN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1929 10TH AVE E
Mailing Address - Street 2:
Mailing Address - City:MILAN
Mailing Address - State:IL
Mailing Address - Zip Code:61264-2953
Mailing Address - Country:US
Mailing Address - Phone:309-787-2600
Mailing Address - Fax:309-787-2643
Practice Address - Street 1:1929 10TH AVE E
Practice Address - Street 2:
Practice Address - City:MILAN
Practice Address - State:IL
Practice Address - Zip Code:61264-2953
Practice Address - Country:US
Practice Address - Phone:309-787-2600
Practice Address - Fax:309-787-2643
Is Sole Proprietor?:No
Enumeration Date:2015-08-17
Last Update Date:2015-11-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL209013092363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily