Provider Demographics
NPI:1417279654
Name:SVETOVICH, KIMBERLY ROBIN
Entity Type:Individual
Prefix:MRS
First Name:KIMBERLY
Middle Name:ROBIN
Last Name:SVETOVICH
Suffix:
Gender:F
Credentials:
Other - Prefix:MRS
Other - First Name:KIMBERLY
Other - Middle Name:ROBIN
Other - Last Name:SVETOVICH
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:LPN
Mailing Address - Street 1:4175 CONDIT RD
Mailing Address - Street 2:
Mailing Address - City:SUNBURY
Mailing Address - State:OH
Mailing Address - Zip Code:43074-9714
Mailing Address - Country:US
Mailing Address - Phone:740-815-3653
Mailing Address - Fax:
Practice Address - Street 1:4175 CONDIT RD
Practice Address - Street 2:
Practice Address - City:SUNBURY
Practice Address - State:OH
Practice Address - Zip Code:43074-9714
Practice Address - Country:US
Practice Address - Phone:740-815-3653
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2010-02-15
Last Update Date:2016-03-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHPN.096557 IV164W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes164W00000XNursing Service ProvidersLicensed Practical Nurse
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH3026442Medicaid