Provider Demographics
NPI:1639118235
Name:MENZER, KIMBERLY ANN PARKER (MA, APRN-BC)
Entity Type:Individual
Prefix:
First Name:KIMBERLY ANN
Middle Name:PARKER
Last Name:MENZER
Suffix:
Gender:F
Credentials:MA, APRN-BC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:223 E 34TH ST
Mailing Address - Street 2:
Mailing Address - City:NEW YORK
Mailing Address - State:NY
Mailing Address - Zip Code:10016-4852
Mailing Address - Country:US
Mailing Address - Phone:646-558-0802
Mailing Address - Fax:646-385-7164
Practice Address - Street 1:223 E 34TH ST
Practice Address - Street 2:
Practice Address - City:NEW YORK
Practice Address - State:NY
Practice Address - Zip Code:10016-4852
Practice Address - Country:US
Practice Address - Phone:646-558-0802
Practice Address - Fax:646-385-7164
Is Sole Proprietor?:Yes
Enumeration Date:2006-06-06
Last Update Date:2015-11-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY304216363LA2200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LA2200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerAdult Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY304216OtherNP LICENSE