Provider Demographics
NPI:1295020584
Name:SANSONE, KIMBERLY MICHELE (RN)
Entity Type:Individual
Prefix:
First Name:KIMBERLY
Middle Name:MICHELE
Last Name:SANSONE
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 1:905 IPSWICH PL
Mailing Address - Street 2:APT. B
Mailing Address - City:CORAM
Mailing Address - State:NY
Mailing Address - Zip Code:11727-5414
Mailing Address - Country:US
Mailing Address - Phone:631-374-5936
Mailing Address - Fax:
Practice Address - Street 1:905 IPSWICH PL
Practice Address - Street 2:APT. B
Practice Address - City:CORAM
Practice Address - State:NY
Practice Address - Zip Code:11727-5414
Practice Address - Country:US
Practice Address - Phone:631-374-5936
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2011-06-14
Last Update Date:2012-11-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY630860-1163W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163W00000XNursing Service ProvidersRegistered Nurse