Provider Demographics
NPI:1104066372
Name:MARTIN, KIMBERLY E (RN)
Entity type:Individual
Prefix:
First Name:KIMBERLY
Middle Name:E
Last Name:MARTIN
Suffix:
Gender:F
Credentials:RN
Other - Prefix:
Other - First Name:KIMBERLY
Other - Middle Name:E
Other - Last Name:DUFFEY
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:RN
Mailing Address - Street 1:2600 VICTORY PKWY
Mailing Address - Street 2:
Mailing Address - City:CINCINNATI
Mailing Address - State:OH
Mailing Address - Zip Code:45206-1711
Mailing Address - Country:US
Mailing Address - Phone:513-872-5863
Mailing Address - Fax:513-872-5182
Practice Address - Street 1:5837 HAMILTON AVE
Practice Address - Street 2:
Practice Address - City:CINCINNATI
Practice Address - State:OH
Practice Address - Zip Code:45224-2923
Practice Address - Country:US
Practice Address - Phone:513-547-7577
Practice Address - Fax:513-541-5895
Is Sole Proprietor?:No
Enumeration Date:2009-03-02
Last Update Date:2009-03-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHRN 289033163W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163W00000XNursing Service ProvidersRegistered Nurse