Provider Demographics
NPI:1568945871
Name:BAX, KIMBERLY (BSNRN)
Entity Type:Individual
Prefix:
First Name:KIMBERLY
Middle Name:
Last Name:BAX
Suffix:
Gender:F
Credentials:BSNRN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2030 W GARFIELD ST
Mailing Address - Street 2:
Mailing Address - City:LINCOLN
Mailing Address - State:NE
Mailing Address - Zip Code:68522-1453
Mailing Address - Country:US
Mailing Address - Phone:402-560-3909
Mailing Address - Fax:
Practice Address - Street 1:2030 W GARFIELD ST
Practice Address - Street 2:
Practice Address - City:LINCOLN
Practice Address - State:NE
Practice Address - Zip Code:68522-1453
Practice Address - Country:US
Practice Address - Phone:402-560-3909
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2018-09-12
Last Update Date:2018-09-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NE53241163W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163W00000XNursing Service ProvidersRegistered Nurse