Provider Demographics
NPI:1841589801
Name:WEISS, KIMBERLY MICHELE
Entity Type:Individual
Prefix:MS
First Name:KIMBERLY
Middle Name:MICHELE
Last Name:WEISS
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 1:1077 CIVIC CENTER BLVD
Mailing Address - Street 2:
Mailing Address - City:YUBA CITY
Mailing Address - State:CA
Mailing Address - Zip Code:95993-3002
Mailing Address - Country:US
Mailing Address - Phone:530-674-7621
Mailing Address - Fax:
Practice Address - Street 1:1077 CIVIC CENTER BLVD
Practice Address - Street 2:
Practice Address - City:YUBA CITY
Practice Address - State:CA
Practice Address - Zip Code:95993-3002
Practice Address - Country:US
Practice Address - Phone:530-674-7621
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2011-03-30
Last Update Date:2011-03-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA202234164X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes164X00000XNursing Service ProvidersLicensed Vocational Nurse