Provider Demographics
NPI:1720365455
Name:RUMPH, KIMBERLY N
Entity Type:Individual
Prefix:
First Name:KIMBERLY
Middle Name:N
Last Name:RUMPH
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:PO BOX 14104
Mailing Address - Street 2:
Mailing Address - City:MERRILLVILLE
Mailing Address - State:IN
Mailing Address - Zip Code:46411-4104
Mailing Address - Country:US
Mailing Address - Phone:219-973-9304
Mailing Address - Fax:
Practice Address - Street 1:341 W 53RD LN
Practice Address - Street 2:
Practice Address - City:MERRILLVILLE
Practice Address - State:IN
Practice Address - Zip Code:46410-1471
Practice Address - Country:US
Practice Address - Phone:219-973-9304
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2011-11-09
Last Update Date:2011-11-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN11-012637-1253Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes253Z00000XAgenciesIn Home Supportive Care