Provider Demographics
NPI:1215526660
Name:NAGY, KIMBER LEE
Entity type:Individual
Prefix:
First Name:KIMBER
Middle Name:LEE
Last Name:NAGY
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 1:1605 MEIJER DR APT 101
Mailing Address - Street 2:
Mailing Address - City:GREENVILLE
Mailing Address - State:MI
Mailing Address - Zip Code:48838-3558
Mailing Address - Country:US
Mailing Address - Phone:248-686-6671
Mailing Address - Fax:
Practice Address - Street 1:1605 MEIJER DR APT 101
Practice Address - Street 2:
Practice Address - City:GREENVILLE
Practice Address - State:MI
Practice Address - Zip Code:48838-3558
Practice Address - Country:US
Practice Address - Phone:248-686-6671
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-01-11
Last Update Date:2021-01-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI4704193928163W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163W00000XNursing Service ProvidersRegistered Nurse