Provider Demographics
NPI:1780331751
Name:DUFFANY, KIMBERLY (LPN)
Entity type:Individual
Prefix:
First Name:KIMBERLY
Middle Name:
Last Name:DUFFANY
Suffix:
Gender:F
Credentials:LPN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:600 TINKHAM RD
Mailing Address - Street 2:
Mailing Address - City:WILBRAHAM
Mailing Address - State:MA
Mailing Address - Zip Code:01095-2428
Mailing Address - Country:US
Mailing Address - Phone:413-335-0621
Mailing Address - Fax:
Practice Address - Street 1:600 TINKHAM RD
Practice Address - Street 2:
Practice Address - City:WILBRAHAM
Practice Address - State:MA
Practice Address - Zip Code:01095-2428
Practice Address - Country:US
Practice Address - Phone:413-335-0621
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2022-03-09
Last Update Date:2022-03-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MALN41750164W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes164W00000XNursing Service ProvidersLicensed Practical Nurse