Provider Demographics
NPI:1720117658
Name:MCWILLIAMS, KIMBERLY SUE (STATE TESTED NURSES)
Entity Type:Individual
Prefix:MRS
First Name:KIMBERLY
Middle Name:SUE
Last Name:MCWILLIAMS
Suffix:
Gender:F
Credentials:STATE TESTED NURSES
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1360 DREXEL AVE NW
Mailing Address - Street 2:
Mailing Address - City:WARREN
Mailing Address - State:OH
Mailing Address - Zip Code:44485-2112
Mailing Address - Country:US
Mailing Address - Phone:330-392-0359
Mailing Address - Fax:
Practice Address - Street 1:1406 MAXWELL AVE NW
Practice Address - Street 2:APT# B
Practice Address - City:WARREN
Practice Address - State:OH
Practice Address - Zip Code:44485-2130
Practice Address - Country:US
Practice Address - Phone:330-555-9589
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-03-05
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes374U00000XNursing Service Related ProvidersHome Health Aide