Provider Demographics
NPI:1780074419
Name:HALBLAUB, KIM (RN)
Entity type:Individual
Prefix:
First Name:KIM
Middle Name:
Last Name:HALBLAUB
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 1:825 SMITH RD
Mailing Address - Street 2:
Mailing Address - City:ASHLAND
Mailing Address - State:OH
Mailing Address - Zip Code:44805-3644
Mailing Address - Country:US
Mailing Address - Phone:419-289-7969
Mailing Address - Fax:
Practice Address - Street 1:825 SMITH RD
Practice Address - Street 2:
Practice Address - City:ASHLAND
Practice Address - State:OH
Practice Address - Zip Code:44805-3644
Practice Address - Country:US
Practice Address - Phone:419-289-7969
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2015-02-03
Last Update Date:2015-02-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHRN.234788163W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163W00000XNursing Service ProvidersRegistered Nurse