Provider Demographics
NPI:1497988778
Name:CROESE, KIMBERLY S (RN)
Entity Type:Individual
Prefix:MR
First Name:KIMBERLY
Middle Name:S
Last Name:CROESE
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:CMR 454
Mailing Address - Street 2:BOX 1963
Mailing Address - City:APO
Mailing Address - State:AE
Mailing Address - Zip Code:09250
Mailing Address - Country:US
Mailing Address - Phone:314-467-3735
Mailing Address - Fax:
Practice Address - Street 1:BIRKENSTRASSE 20
Practice Address - Street 2:
Practice Address - City:WEIHENZELL
Practice Address - State:DEUTCHLAND
Practice Address - Zip Code:91629
Practice Address - Country:DE
Practice Address - Phone:0980-295-2517
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2009-09-02
Last Update Date:2009-09-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH191177163WC0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163WC0400XNursing Service ProvidersRegistered NurseCase Management