Provider Demographics
NPI:1194171801
Name:KIMBLE, OLIVIA (LTM, CPM, MSM)
Entity type:Individual
Prefix:
First Name:OLIVIA
Middle Name:
Last Name:KIMBLE
Suffix:
Gender:F
Credentials:LTM, CPM, MSM
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1001 TRAIL VIEW LN SE
Mailing Address - Street 2:
Mailing Address - City:PINE ISLAND
Mailing Address - State:MN
Mailing Address - Zip Code:55963-8608
Mailing Address - Country:US
Mailing Address - Phone:720-982-9530
Mailing Address - Fax:
Practice Address - Street 1:1001 TRAIL VIEW LN SE
Practice Address - Street 2:
Practice Address - City:PINE ISLAND
Practice Address - State:MN
Practice Address - Zip Code:55963-8608
Practice Address - Country:US
Practice Address - Phone:720-982-9530
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2016-05-11
Last Update Date:2021-01-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
374J00000X
MN1083176B00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes176B00000XOther Service ProvidersMidwife
No374J00000XNursing Service Related ProvidersDoula