Provider Demographics
NPI:1821317876
Name:WELLER, KIMBERLY ANN (RNC)
Entity Type:Individual
Prefix:MRS
First Name:KIMBERLY
Middle Name:ANN
Last Name:WELLER
Suffix:
Gender:F
Credentials:RNC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:43097 WOODWARD AVE
Mailing Address - Street 2:SUITE 201
Mailing Address - City:BLOOMFIELD HILLS
Mailing Address - State:MI
Mailing Address - Zip Code:48302-5041
Mailing Address - Country:US
Mailing Address - Phone:248-454-9000
Mailing Address - Fax:248-454-9100
Practice Address - Street 1:43097 WOODWARD AVE
Practice Address - Street 2:SUITE 201
Practice Address - City:BLOOMFIELD HILLS
Practice Address - State:MI
Practice Address - Zip Code:48302-5041
Practice Address - Country:US
Practice Address - Phone:248-454-9000
Practice Address - Fax:248-454-9100
Is Sole Proprietor?:No
Enumeration Date:2010-05-28
Last Update Date:2010-05-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI4704159179163W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163W00000XNursing Service ProvidersRegistered Nurse