Provider Demographics
NPI:1184930265
Name:SODERSTROM, KIMBERLY ROERS (CNIM)
Entity type:Individual
Prefix:MRS
First Name:KIMBERLY
Middle Name:ROERS
Last Name:SODERSTROM
Suffix:
Gender:F
Credentials:CNIM
Other - Prefix:
Other - First Name:
Other - Middle Name:
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Other - Credentials:
Mailing Address - Street 1:812 AVIS DR
Mailing Address - Street 2:
Mailing Address - City:ANN ARBOR
Mailing Address - State:MI
Mailing Address - Zip Code:48108-9649
Mailing Address - Country:US
Mailing Address - Phone:734-717-7558
Mailing Address - Fax:734-622-0452
Practice Address - Street 1:812 AVIS DR
Practice Address - Street 2:
Practice Address - City:ANN ARBOR
Practice Address - State:MI
Practice Address - Zip Code:48108-9649
Practice Address - Country:US
Practice Address - Phone:734-717-7558
Practice Address - Fax:734-622-0452
Is Sole Proprietor?:No
Enumeration Date:2010-08-26
Last Update Date:2010-08-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes246ZE0600XTechnologists, Technicians & Other Technical Service ProvidersSpecialist/Technologist, OtherElectroneurodiagnostic