Provider Demographics
NPI:1720014889
Name:KIMBALL, CHRISTINE VILLAGE (CRNA)
Entity Type:Individual
Prefix:MRS
First Name:CHRISTINE
Middle Name:VILLAGE
Last Name:KIMBALL
Suffix:
Gender:F
Credentials:CRNA
Other - Prefix:
Other - First Name:CHRISTINE
Other - Middle Name:MARIE
Other - Last Name:VILLAGE
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:CRNA
Mailing Address - Street 1:176 H ST
Mailing Address - Street 2:
Mailing Address - City:BOSTON
Mailing Address - State:MA
Mailing Address - Zip Code:02127-4111
Mailing Address - Country:US
Mailing Address - Phone:781-929-1820
Mailing Address - Fax:
Practice Address - Street 1:WINCHESTER ANESTHESIA ASSOCIATES
Practice Address - Street 2:41 HIGHLAND AVENUE
Practice Address - City:WINCHESTER
Practice Address - State:MA
Practice Address - Zip Code:01890
Practice Address - Country:US
Practice Address - Phone:781-729-7243
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-06-23
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA203924163W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163W00000XNursing Service ProvidersRegistered Nurse