Provider Demographics
NPI:1720579220
Name:PFEIFER, KIMBERLY ANN (MS, RD, LMNT)
Entity Type:Individual
Prefix:
First Name:KIMBERLY
Middle Name:ANN
Last Name:PFEIFER
Suffix:
Gender:F
Credentials:MS, RD, LMNT
Other - Prefix:
Other - First Name:KIMBERLY
Other - Middle Name:ANN
Other - Last Name:WOLFER
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MS, RD, LMNT
Mailing Address - Street 1:2260 CIRCLE DR
Mailing Address - Street 2:
Mailing Address - City:COLUMBUS
Mailing Address - State:NE
Mailing Address - Zip Code:68601-3040
Mailing Address - Country:US
Mailing Address - Phone:402-910-9168
Mailing Address - Fax:
Practice Address - Street 1:706 EWING ST
Practice Address - Street 2:
Practice Address - City:GENOA
Practice Address - State:NE
Practice Address - Zip Code:68640-3035
Practice Address - Country:US
Practice Address - Phone:402-993-2283
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-05-21
Last Update Date:2018-05-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NE1141133V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, Registered