Provider Demographics
NPI:1336904739
Name:LALLATHIN, KIMBERLY S
Entity type:Individual
Prefix:
First Name:KIMBERLY
Middle Name:S
Last Name:LALLATHIN
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 1:6597 ROSWELL RD SW
Mailing Address - Street 2:
Mailing Address - City:SHERRODSVILLE
Mailing Address - State:OH
Mailing Address - Zip Code:44675-9740
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:6597 ROSWELL RD SW
Practice Address - Street 2:
Practice Address - City:SHERRODSVILLE
Practice Address - State:OH
Practice Address - Zip Code:44675-9740
Practice Address - Country:US
Practice Address - Phone:330-495-2174
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-02-15
Last Update Date:2024-02-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes376J00000XNursing Service Related ProvidersHomemaker