Provider Demographics
NPI:1306295183
Name:ST.ONGE, KIMBERLEY
Entity type:Individual
Prefix:MS
First Name:KIMBERLEY
Middle Name:
Last Name:ST.ONGE
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 1:23205 YARROW AVE
Mailing Address - Street 2:
Mailing Address - City:MACOMB
Mailing Address - State:MI
Mailing Address - Zip Code:48042-1058
Mailing Address - Country:US
Mailing Address - Phone:586-855-8311
Mailing Address - Fax:
Practice Address - Street 1:23205 YARROW AVE
Practice Address - Street 2:
Practice Address - City:MACOMB
Practice Address - State:MI
Practice Address - Zip Code:48042-1058
Practice Address - Country:US
Practice Address - Phone:586-855-8311
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2016-06-13
Last Update Date:2016-06-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes247200000XTechnologists, Technicians & Other Technical Service ProvidersTechnician, Other