Provider Demographics
NPI:1518307503
Name:PERZIA, KIMBERLY GWEN (LPN)
Entity Type:Individual
Prefix:
First Name:KIMBERLY
Middle Name:GWEN
Last Name:PERZIA
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 1:35 EVANS ST
Mailing Address - Street 2:
Mailing Address - City:PRINGLE
Mailing Address - State:PA
Mailing Address - Zip Code:18704-1837
Mailing Address - Country:US
Mailing Address - Phone:570-991-1368
Mailing Address - Fax:
Practice Address - Street 1:35 EVANS ST
Practice Address - Street 2:
Practice Address - City:PRINGLE
Practice Address - State:PA
Practice Address - Zip Code:18704-1837
Practice Address - Country:US
Practice Address - Phone:570-991-1368
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2013-07-05
Last Update Date:2013-07-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAPN282849164W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes164W00000XNursing Service ProvidersLicensed Practical Nurse