Provider Demographics
NPI:1780026047
Name:KILMER, ROCHELLE ANN
Entity Type:Individual
Prefix:
First Name:ROCHELLE
Middle Name:ANN
Last Name:KILMER
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 1:12916 W BUTTER BUSH ST
Mailing Address - Street 2:
Mailing Address - City:TUCSON
Mailing Address - State:AZ
Mailing Address - Zip Code:85743-7269
Mailing Address - Country:US
Mailing Address - Phone:520-870-1213
Mailing Address - Fax:
Practice Address - Street 1:12916 W BUTTER BUSH ST
Practice Address - Street 2:
Practice Address - City:TUCSON
Practice Address - State:AZ
Practice Address - Zip Code:85743-7269
Practice Address - Country:US
Practice Address - Phone:520-870-1213
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2013-07-26
Last Update Date:2013-07-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZ2975453385HR2055X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes385HR2055XRespite Care FacilityRespite CareRespite Care, Mental Illness, Child
Provider Identifiers
StateIdentifier IDID TypeIssuer
AZ2975453OtherOLCR LICENSE