Provider Demographics
NPI:1568759561
Name:IGNATIUS, KIM (LPN)
Entity Type:Individual
Prefix:
First Name:KIM
Middle Name:
Last Name:IGNATIUS
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 1:3562 COUNTY ROAD JG
Mailing Address - Street 2:
Mailing Address - City:BLUE MOUNDS
Mailing Address - State:WI
Mailing Address - Zip Code:53517-9703
Mailing Address - Country:US
Mailing Address - Phone:608-220-4771
Mailing Address - Fax:
Practice Address - Street 1:3562 COUNTY ROAD JG
Practice Address - Street 2:
Practice Address - City:BLUE MOUNDS
Practice Address - State:WI
Practice Address - Zip Code:53517-9703
Practice Address - Country:US
Practice Address - Phone:608-220-4771
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2011-06-29
Last Update Date:2011-06-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI27885-31164W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes164W00000XNursing Service ProvidersLicensed Practical Nurse