Provider Demographics
NPI:1518029248
Name:VANWINGEN, KIMBERLY A (CNM RN)
Entity Type:Individual
Prefix:
First Name:KIMBERLY
Middle Name:A
Last Name:VANWINGEN
Suffix:
Gender:F
Credentials:CNM RN
Other - Prefix:
Other - First Name:KIMBERLY
Other - Middle Name:A
Other - Last Name:NABER
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:CNM RN
Mailing Address - Street 1:109 S JACKSON ST
Mailing Address - Street 2:
Mailing Address - City:SPRING LAKE
Mailing Address - State:MI
Mailing Address - Zip Code:49456-2095
Mailing Address - Country:US
Mailing Address - Phone:616-842-7406
Mailing Address - Fax:616-844-7056
Practice Address - Street 1:109 S JACKSON ST
Practice Address - Street 2:
Practice Address - City:SPRING LAKE
Practice Address - State:MI
Practice Address - Zip Code:49456-2095
Practice Address - Country:US
Practice Address - Phone:616-842-7406
Practice Address - Fax:616-844-7056
Is Sole Proprietor?:Yes
Enumeration Date:2006-12-16
Last Update Date:2021-02-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI4704169207367A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes367A00000XPhysician Assistants & Advanced Practice Nursing ProvidersAdvanced Practice Midwife
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI4208758280OtherBCBS
MIP111269OtherBLUE CARE NETWORK
MI382854385OtherTAX ID