Provider Demographics
NPI:1356919807
Name:INGEBREDTSEN, KIMBERLY KIELE (RN)
Entity type:Individual
Prefix:
First Name:KIMBERLY
Middle Name:KIELE
Last Name:INGEBREDTSEN
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 1:6950 SULLY LN
Mailing Address - Street 2:
Mailing Address - City:WEST RICHLAND
Mailing Address - State:WA
Mailing Address - Zip Code:99353-8007
Mailing Address - Country:US
Mailing Address - Phone:202-669-1693
Mailing Address - Fax:
Practice Address - Street 1:6950 SULLY LN
Practice Address - Street 2:
Practice Address - City:WEST RICHLAND
Practice Address - State:WA
Practice Address - Zip Code:99353-8007
Practice Address - Country:US
Practice Address - Phone:202-669-1693
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-06-11
Last Update Date:2021-06-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WARN60905818163WG0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163WG0000XNursing Service ProvidersRegistered NurseGeneral Practice
Provider Identifiers
StateIdentifier IDID TypeIssuer
WARN60905818OtherRN