Provider Demographics
NPI:1881380160
Name:QUINTANA, KIMBERLY M (RN)
Entity type:Individual
Prefix:
First Name:KIMBERLY
Middle Name:M
Last Name:QUINTANA
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 1:477 23RD ST
Mailing Address - Street 2:
Mailing Address - City:OGDEN
Mailing Address - State:UT
Mailing Address - Zip Code:84401-1507
Mailing Address - Country:US
Mailing Address - Phone:801-399-7250
Mailing Address - Fax:801-399-7233
Practice Address - Street 1:477 23RD ST
Practice Address - Street 2:
Practice Address - City:OGDEN
Practice Address - State:UT
Practice Address - Zip Code:84401-1507
Practice Address - Country:US
Practice Address - Phone:801-399-7250
Practice Address - Fax:801-399-7233
Is Sole Proprietor?:No
Enumeration Date:2023-04-11
Last Update Date:2023-04-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
UT8546712-3102163WC1500X, 163WH0500X, 163WM0705X, 163W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163W00000XNursing Service ProvidersRegistered Nurse
No163WC1500XNursing Service ProvidersRegistered NurseCommunity Health
No163WH0500XNursing Service ProvidersRegistered NurseHemodialysis
No163WM0705XNursing Service ProvidersRegistered NurseMedical-Surgical