Provider Demographics
NPI:1699115337
Name:CRONK, KIMBERLY (RN)
Entity type:Individual
Prefix:MS
First Name:KIMBERLY
Middle Name:
Last Name:CRONK
Suffix:
Gender:F
Credentials:RN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1019 HUEBSCH BLVD
Mailing Address - Street 2:
Mailing Address - City:EAU CLAIRE
Mailing Address - State:WI
Mailing Address - Zip Code:54701-4233
Mailing Address - Country:US
Mailing Address - Phone:715-475-8119
Mailing Address - Fax:
Practice Address - Street 1:1019 HUEBSCH BLVD
Practice Address - Street 2:
Practice Address - City:EAU CLAIRE
Practice Address - State:WI
Practice Address - Zip Code:54701-4233
Practice Address - Country:US
Practice Address - Phone:715-475-8119
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2013-06-26
Last Update Date:2013-06-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI167100-30163W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163W00000XNursing Service ProvidersRegistered Nurse