Provider Demographics
NPI:1073750485
Name:MOL, KIMBERLY RAE (RN)
Entity type:Individual
Prefix:
First Name:KIMBERLY
Middle Name:RAE
Last Name:MOL
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 1:10879 RILEY ST
Mailing Address - Street 2:
Mailing Address - City:ZEELAND
Mailing Address - State:MI
Mailing Address - Zip Code:49464-6857
Mailing Address - Country:US
Mailing Address - Phone:616-366-6875
Mailing Address - Fax:
Practice Address - Street 1:14928 16 MILE RD
Practice Address - Street 2:
Practice Address - City:LEROY
Practice Address - State:MI
Practice Address - Zip Code:49655-8293
Practice Address - Country:US
Practice Address - Phone:231-768-4675
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2009-01-07
Last Update Date:2009-01-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI4704201722163WH0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163WH0200XNursing Service ProvidersRegistered NurseHome Health