Provider Demographics
NPI:1265092571
Name:WISCHMEYER, KIMBERLY A (RN)
Entity type:Individual
Prefix:
First Name:KIMBERLY
Middle Name:A
Last Name:WISCHMEYER
Suffix:
Gender:F
Credentials:RN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:13658 ROAD 8
Mailing Address - Street 2:
Mailing Address - City:OTTAWA
Mailing Address - State:OH
Mailing Address - Zip Code:45875-9502
Mailing Address - Country:US
Mailing Address - Phone:419-234-7640
Mailing Address - Fax:
Practice Address - Street 1:13658 ROAD 8
Practice Address - Street 2:
Practice Address - City:OTTAWA
Practice Address - State:OH
Practice Address - Zip Code:45875-9502
Practice Address - Country:US
Practice Address - Phone:419-234-7640
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2019-06-18
Last Update Date:2019-06-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHRN.335074163W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163W00000XNursing Service ProvidersRegistered Nurse