Provider Demographics
NPI:1417752031
Name:KIMBALL, SADIE ALEXANDRA
Entity type:Individual
Prefix:
First Name:SADIE
Middle Name:ALEXANDRA
Last Name:KIMBALL
Suffix:
Gender:
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:633 ALMA AVE APT 8
Mailing Address - Street 2:
Mailing Address - City:OAKLAND
Mailing Address - State:CA
Mailing Address - Zip Code:94610-3850
Mailing Address - Country:US
Mailing Address - Phone:805-259-5285
Mailing Address - Fax:
Practice Address - Street 1:633 ALMA AVE APT 8
Practice Address - Street 2:
Practice Address - City:OAKLAND
Practice Address - State:CA
Practice Address - Zip Code:94610-3850
Practice Address - Country:US
Practice Address - Phone:805-259-5285
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2025-02-17
Last Update Date:2025-02-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes374J00000XNursing Service Related ProvidersDoula