Provider Demographics
NPI:1689194839
Name:BALOGH, KIMBERLY-SUN RENEE
Entity Type:Individual
Prefix:
First Name:KIMBERLY-SUN
Middle Name:RENEE
Last Name:BALOGH
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:362 JENNINGS AVE APT B
Mailing Address - Street 2:
Mailing Address - City:MANSFIELD
Mailing Address - State:OH
Mailing Address - Zip Code:44907-1486
Mailing Address - Country:US
Mailing Address - Phone:567-303-4659
Mailing Address - Fax:
Practice Address - Street 1:362 JENNINGS AVE APT B
Practice Address - Street 2:
Practice Address - City:MANSFIELD
Practice Address - State:OH
Practice Address - Zip Code:44907-1486
Practice Address - Country:US
Practice Address - Phone:567-303-4659
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2017-06-20
Last Update Date:2022-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH401730170315376K00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes376K00000XNursing Service Related ProvidersNurse's Aide