Provider Demographics
NPI:1790063741
Name:DOELL, KIM
Entity Type:Individual
Prefix:
First Name:KIM
Middle Name:
Last Name:DOELL
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 1:1537 PARK PL
Mailing Address - Street 2:SUITE 200
Mailing Address - City:GREEN BAY
Mailing Address - State:WI
Mailing Address - Zip Code:54304-1974
Mailing Address - Country:US
Mailing Address - Phone:920-498-8650
Mailing Address - Fax:920-498-0945
Practice Address - Street 1:1537 PARK PL
Practice Address - Street 2:SUITE 200
Practice Address - City:GREEN BAY
Practice Address - State:WI
Practice Address - Zip Code:54304-1974
Practice Address - Country:US
Practice Address - Phone:920-498-8650
Practice Address - Fax:920-498-0945
Is Sole Proprietor?:No
Enumeration Date:2011-07-25
Last Update Date:2011-07-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes246ZC0007XTechnologists, Technicians & Other Technical Service ProvidersSpecialist/Technologist, OtherSurgical Assistant