Provider Demographics
NPI:1710769971
Name:SMALLWOOD, KIMBERLY NOKOLE (REGISTERED NURSE)
Entity Type:Individual
Prefix:
First Name:KIMBERLY
Middle Name:NOKOLE
Last Name:SMALLWOOD
Suffix:
Gender:F
Credentials:REGISTERED NURSE
Other - Prefix:
Other - First Name:KIMBERLY
Other - Middle Name:NOKOLE
Other - Last Name:BELL
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:REGISTERED NURSE
Mailing Address - Street 1:31 W PLEASANT ST FL 1
Mailing Address - Street 2:
Mailing Address - City:RIVER ROUGE
Mailing Address - State:MI
Mailing Address - Zip Code:48218-1337
Mailing Address - Country:US
Mailing Address - Phone:313-740-3409
Mailing Address - Fax:
Practice Address - Street 1:31 W PLEASANT ST FL 1
Practice Address - Street 2:
Practice Address - City:RIVER ROUGE
Practice Address - State:MI
Practice Address - Zip Code:48218-1337
Practice Address - Country:US
Practice Address - Phone:313-740-3409
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2023-10-20
Last Update Date:2023-10-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI4704373175163WG0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163WG0000XNursing Service ProvidersRegistered NurseGeneral Practice