Provider Demographics
NPI:1275022022
Name:KUIMJIAN, MARTI (RN)
Entity Type:Individual
Prefix:
First Name:MARTI
Middle Name:
Last Name:KUIMJIAN
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 1:1205 N 62ND ST STE 212
Mailing Address - Street 2:
Mailing Address - City:WAUWATOSA
Mailing Address - State:WI
Mailing Address - Zip Code:53213-3071
Mailing Address - Country:US
Mailing Address - Phone:219-682-4231
Mailing Address - Fax:
Practice Address - Street 1:1205 N 62ND ST STE 212
Practice Address - Street 2:
Practice Address - City:WAUWATOSA
Practice Address - State:WI
Practice Address - Zip Code:53213-3071
Practice Address - Country:US
Practice Address - Phone:219-682-4231
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-05-08
Last Update Date:2018-05-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI229325163W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163W00000XNursing Service ProvidersRegistered Nurse