Provider Demographics
NPI:1285319921
Name:SNELL, KIMBERLY DANIELLE (LPN)
Entity type:Individual
Prefix:
First Name:KIMBERLY
Middle Name:DANIELLE
Last Name:SNELL
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:A1 BENTLEY ROAD
Mailing Address - Street 2:B18 TUDOR COURT
Mailing Address - City:EASTAMPTON
Mailing Address - State:NJ
Mailing Address - Zip Code:08060
Mailing Address - Country:US
Mailing Address - Phone:609-743-9706
Mailing Address - Fax:
Practice Address - Street 1:A1 BENTLEY ROAD
Practice Address - Street 2:B18 TUDOR COURT
Practice Address - City:EASTAMPTON
Practice Address - State:NJ
Practice Address - Zip Code:08060
Practice Address - Country:US
Practice Address - Phone:609-743-9706
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2023-06-20
Last Update Date:2023-06-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
251J00000X, 374J00000X
NJ26NP07950200164W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes164W00000XNursing Service ProvidersLicensed Practical Nurse
No251J00000XAgenciesNursing Care
No374J00000XNursing Service Related ProvidersDoulaGroup - Multi-Specialty