Provider Demographics
NPI:1609093244
Name:DUBOIS, KIMBERLY ELLEN (RN)
Entity Type:Individual
Prefix:MRS
First Name:KIMBERLY
Middle Name:ELLEN
Last Name:DUBOIS
Suffix:
Gender:F
Credentials:RN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:47-291 HUI IWA ST
Mailing Address - Street 2:UNIT C
Mailing Address - City:KANEOHE
Mailing Address - State:HI
Mailing Address - Zip Code:96744-4330
Mailing Address - Country:US
Mailing Address - Phone:808-590-1728
Mailing Address - Fax:
Practice Address - Street 1:BLDG.1407- MAKALAPA ROAD
Practice Address - Street 2:
Practice Address - City:PEARL HARBOR
Practice Address - State:HI
Practice Address - Zip Code:96814-3610
Practice Address - Country:US
Practice Address - Phone:808-473-0247
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-04-18
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
HI55912163WE0003X
IL163WE0003X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163WE0003XNursing Service ProvidersRegistered NurseEmergency