Provider Demographics
NPI:1437767050
Name:DAMIAN, KIMBERLEY (LPN)
Entity Type:Individual
Prefix:
First Name:KIMBERLEY
Middle Name:
Last Name:DAMIAN
Suffix:
Gender:F
Credentials:LPN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1902 E KESSLER BLVD
Mailing Address - Street 2:
Mailing Address - City:LONGVIEW
Mailing Address - State:WA
Mailing Address - Zip Code:98632-1844
Mailing Address - Country:US
Mailing Address - Phone:360-575-7580
Mailing Address - Fax:
Practice Address - Street 1:1902 E KESSLER BLVD
Practice Address - Street 2:
Practice Address - City:LONGVIEW
Practice Address - State:WA
Practice Address - Zip Code:98632-1844
Practice Address - Country:US
Practice Address - Phone:360-575-7580
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-07-20
Last Update Date:2020-07-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WALP60605308164W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes164W00000XNursing Service ProvidersLicensed Practical Nurse