Provider Demographics
NPI:1760194286
Name:DUBOIS, KIMBERLY ANNE (RN)
Entity Type:Individual
Prefix:
First Name:KIMBERLY
Middle Name:ANNE
Last Name:DUBOIS
Suffix:
Gender:F
Credentials:RN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:83 SUMMER ST
Mailing Address - Street 2:
Mailing Address - City:PORTER
Mailing Address - State:ME
Mailing Address - Zip Code:04068-3537
Mailing Address - Country:US
Mailing Address - Phone:207-625-9415
Mailing Address - Fax:207-625-9520
Practice Address - Street 1:83 SUMMER ST
Practice Address - Street 2:
Practice Address - City:PORTER
Practice Address - State:ME
Practice Address - Zip Code:04068-3537
Practice Address - Country:US
Practice Address - Phone:207-625-9415
Practice Address - Fax:207-625-9520
Is Sole Proprietor?:No
Enumeration Date:2022-12-15
Last Update Date:2022-12-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MERN59131163WH0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163WH0200XNursing Service ProvidersRegistered NurseHome Health