Provider Demographics
NPI:1063226256
Name:KONWINSKI, KIMBERLY
Entity type:Individual
Prefix:
First Name:KIMBERLY
Middle Name:
Last Name:KONWINSKI
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:112 N 5TH ST
Mailing Address - Street 2:
Mailing Address - City:NEWMAN GROVE
Mailing Address - State:NE
Mailing Address - Zip Code:68758-6050
Mailing Address - Country:US
Mailing Address - Phone:308-482-0922
Mailing Address - Fax:
Practice Address - Street 1:112 N 5TH ST
Practice Address - Street 2:
Practice Address - City:NEWMAN GROVE
Practice Address - State:NE
Practice Address - Zip Code:68758-6050
Practice Address - Country:US
Practice Address - Phone:308-482-0922
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2025-02-06
Last Update Date:2025-02-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NE372500000X, 3747P1801X, 372600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes372600000XNursing Service Related ProvidersAdult CompanionGroup - Multi-Specialty
No372500000XNursing Service Related ProvidersChore ProviderGroup - Multi-Specialty
No3747P1801XNursing Service Related ProvidersTechnicianPersonal Care AttendantGroup - Multi-Specialty