Provider Demographics
NPI:1891017265
Name:DUNKINS HERNDON, KIM LATONIA-FAYE (RN)
Entity Type:Individual
Prefix:MRS
First Name:KIM
Middle Name:LATONIA-FAYE
Last Name:DUNKINS HERNDON
Suffix:
Gender:F
Credentials:RN
Other - Prefix:
Other - First Name:KIM
Other - Middle Name:LATONIA-FAYE
Other - Last Name:DUNKINS-HERNDON
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:LPN
Mailing Address - Street 1:2114 OXFORD ST
Mailing Address - Street 2:
Mailing Address - City:TWINSBURG
Mailing Address - State:OH
Mailing Address - Zip Code:44087-2028
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:2114 OXFORD ST
Practice Address - Street 2:
Practice Address - City:TWINSBURG
Practice Address - State:OH
Practice Address - Zip Code:44087-2028
Practice Address - Country:US
Practice Address - Phone:216-577-5460
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2010-02-25
Last Update Date:2010-02-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHRN357075163W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163W00000XNursing Service ProvidersRegistered Nurse