Provider Demographics
NPI:1740830470
Name:KLEIN, KIMBERLY DANIELLE (KIMBERLY)
Entity type:Individual
Prefix:
First Name:KIMBERLY
Middle Name:DANIELLE
Last Name:KLEIN
Suffix:
Gender:F
Credentials:KIMBERLY
Other - Prefix:
Other - First Name:KIMBERLY
Other - Middle Name:DANIELLE
Other - Last Name:MCDONALD
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:13232 SQUAK MOUNTAIN RD SE
Mailing Address - Street 2:
Mailing Address - City:ISSAQUAH
Mailing Address - State:WA
Mailing Address - Zip Code:98027-8537
Mailing Address - Country:US
Mailing Address - Phone:540-831-0569
Mailing Address - Fax:
Practice Address - Street 1:13232 SQUAK MOUNTAIN RD SE
Practice Address - Street 2:
Practice Address - City:ISSAQUAH
Practice Address - State:WA
Practice Address - Zip Code:98027-8537
Practice Address - Country:US
Practice Address - Phone:540-831-0569
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2019-09-15
Last Update Date:2019-09-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3747A0650XNursing Service Related ProvidersTechnicianAttendant Care Provider