Provider Demographics
NPI:1790390805
Name:KUPFERBERG, KIMBERLY HANNAH (NP)
Entity Type:Individual
Prefix:
First Name:KIMBERLY
Middle Name:HANNAH
Last Name:KUPFERBERG
Suffix:
Gender:F
Credentials:NP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1500 SOUTH FAIRFIELD AVENUE
Mailing Address - Street 2:NR7-109
Mailing Address - City:CHICAGO
Mailing Address - State:IL
Mailing Address - Zip Code:60608
Mailing Address - Country:US
Mailing Address - Phone:773-257-1173
Mailing Address - Fax:773-257-2155
Practice Address - Street 1:1500 S FAIRFIELD AVE FL 4
Practice Address - Street 2:
Practice Address - City:CHICAGO
Practice Address - State:IL
Practice Address - Zip Code:60608-1782
Practice Address - Country:US
Practice Address - Phone:773-257-4325
Practice Address - Fax:773-257-2155
Is Sole Proprietor?:No
Enumeration Date:2020-09-15
Last Update Date:2021-03-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL209021982363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner