Provider Demographics
NPI:1457806077
Name:LASSWELL, KIMBERLY (RN)
Entity type:Individual
Prefix:
First Name:KIMBERLY
Middle Name:
Last Name:LASSWELL
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 1:113 JOY CIR
Mailing Address - Street 2:
Mailing Address - City:CAMDENTON
Mailing Address - State:MO
Mailing Address - Zip Code:65020-3813
Mailing Address - Country:US
Mailing Address - Phone:573-317-9100
Mailing Address - Fax:
Practice Address - Street 1:741 N BUSINESS ROUTE 5
Practice Address - Street 2:
Practice Address - City:CAMDENTON
Practice Address - State:MO
Practice Address - Zip Code:65020-2643
Practice Address - Country:US
Practice Address - Phone:573-317-9100
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2016-08-24
Last Update Date:2016-08-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO2013000412163W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163W00000XNursing Service ProvidersRegistered Nurse