Provider Demographics
NPI:1497896195
Name:KINGSMILL, MARIBETH ANGELA
Entity Type:Individual
Prefix:MRS
First Name:MARIBETH
Middle Name:ANGELA
Last Name:KINGSMILL
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7716 SPRING GARDEN RD
Mailing Address - Street 2:
Mailing Address - City:PARMA
Mailing Address - State:OH
Mailing Address - Zip Code:44129-3630
Mailing Address - Country:US
Mailing Address - Phone:440-884-7882
Mailing Address - Fax:440-884-7882
Practice Address - Street 1:6905 RIDGE RD
Practice Address - Street 2:
Practice Address - City:PARMA
Practice Address - State:OH
Practice Address - Zip Code:44129-5648
Practice Address - Country:US
Practice Address - Phone:440-743-0062
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-02-08
Last Update Date:2007-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes374U00000XNursing Service Related ProvidersHome Health Aide
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH2246957Medicaid