Provider Demographics
NPI:1588004527
Name:KIMA-TABONG, JOAN BEI (NP)
Entity Type:Individual
Prefix:
First Name:JOAN
Middle Name:BEI
Last Name:KIMA-TABONG
Suffix:
Gender:F
Credentials:NP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:186 OLIN AVE
Mailing Address - Street 2:
Mailing Address - City:FITCHBURG
Mailing Address - State:MA
Mailing Address - Zip Code:01420-7026
Mailing Address - Country:US
Mailing Address - Phone:617-308-6130
Mailing Address - Fax:978-345-1218
Practice Address - Street 1:1 HARVARD RD
Practice Address - Street 2:
Practice Address - City:SHIRLEY
Practice Address - State:MA
Practice Address - Zip Code:01464-2434
Practice Address - Country:US
Practice Address - Phone:978-425-4341
Practice Address - Fax:508-792-7888
Is Sole Proprietor?:No
Enumeration Date:2013-07-03
Last Update Date:2013-07-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA252502363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily