Provider Demographics
NPI:1245019157
Name:ERBY, KIMBERLY M
Entity type:Individual
Prefix:
First Name:KIMBERLY
Middle Name:M
Last Name:ERBY
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 1:707 CEDAR ST
Mailing Address - Street 2:
Mailing Address - City:SOUTH BEND
Mailing Address - State:IN
Mailing Address - Zip Code:46617-2054
Mailing Address - Country:US
Mailing Address - Phone:574-335-4678
Mailing Address - Fax:574-335-0660
Practice Address - Street 1:707 CEDAR ST
Practice Address - Street 2:
Practice Address - City:SOUTH BEND
Practice Address - State:IN
Practice Address - Zip Code:46617-2054
Practice Address - Country:US
Practice Address - Phone:574-335-4678
Practice Address - Fax:574-335-0660
Is Sole Proprietor?:No
Enumeration Date:2023-09-28
Last Update Date:2023-09-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes172V00000XOther Service ProvidersCommunity Health Worker