Provider Demographics
NPI:1063755775
Name:KIBA, JULIA ELIZABETH (LPN)
Entity type:Individual
Prefix:MISS
First Name:JULIA
Middle Name:ELIZABETH
Last Name:KIBA
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 1:429 PARKVIEW ST NE
Mailing Address - Street 2:APT. 2
Mailing Address - City:MASSILLON
Mailing Address - State:OH
Mailing Address - Zip Code:44646-5820
Mailing Address - Country:US
Mailing Address - Phone:330-464-0747
Mailing Address - Fax:
Practice Address - Street 1:429 PARKVIEW ST NE
Practice Address - Street 2:APT. 2
Practice Address - City:MASSILLON
Practice Address - State:OH
Practice Address - Zip Code:44646-5820
Practice Address - Country:US
Practice Address - Phone:330-464-0747
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2013-04-01
Last Update Date:2013-04-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH146133164W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes164W00000XNursing Service ProvidersLicensed Practical Nurse