Provider Demographics
NPI:1811508815
Name:WEBSTER, KIMBERLY JUN
Entity type:Individual
Prefix:
First Name:KIMBERLY
Middle Name:JUN
Last Name:WEBSTER
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:KIMBERLY
Other - Middle Name:JUN
Other - Last Name:GUZMAN
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:224 CREEK POINTE CIR
Mailing Address - Street 2:
Mailing Address - City:DURAND
Mailing Address - State:MI
Mailing Address - Zip Code:48429-1668
Mailing Address - Country:US
Mailing Address - Phone:810-445-8741
Mailing Address - Fax:
Practice Address - Street 1:224 CREEK POINTE CIR
Practice Address - Street 2:
Practice Address - City:DURAND
Practice Address - State:MI
Practice Address - Zip Code:48429-1668
Practice Address - Country:US
Practice Address - Phone:810-445-8741
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-08-12
Last Update Date:2020-08-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI4704309920163W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163W00000XNursing Service ProvidersRegistered Nurse