Provider Demographics
NPI:1356308993
Name:DANSER, KIM CHAMBERLAIN (CNM, NP, RN)
Entity Type:Individual
Prefix:MRS
First Name:KIM
Middle Name:CHAMBERLAIN
Last Name:DANSER
Suffix:
Gender:F
Credentials:CNM, NP, RN
Other - Prefix:MRS
Other - First Name:KIMBERLY
Other - Middle Name:L
Other - Last Name:CHAMBERLAIN
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:CNM, NP, RN
Mailing Address - Street 1:1600 E RIVERVIEW AVE
Mailing Address - Street 2:
Mailing Address - City:NAPOLEON
Mailing Address - State:OH
Mailing Address - Zip Code:43545-9805
Mailing Address - Country:US
Mailing Address - Phone:419-599-0055
Mailing Address - Fax:419-599-0089
Practice Address - Street 1:1600 E RIVERVIEW AVE
Practice Address - Street 2:
Practice Address - City:NAPOLEON
Practice Address - State:OH
Practice Address - Zip Code:43545-9805
Practice Address - Country:US
Practice Address - Phone:419-599-0055
Practice Address - Fax:419-599-0089
Is Sole Proprietor?:No
Enumeration Date:2006-04-27
Last Update Date:2023-11-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NYF001165367A00000X
OH0019516367A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes367A00000XPhysician Assistants & Advanced Practice Nursing ProvidersAdvanced Practice Midwife
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY02648635Medicaid
OH0486105Medicaid
NYQ29783Medicare UPIN
NYRA4958Medicare PIN