Provider Demographics
NPI:1962363861
Name:KIMBALL, LAURA
Entity type:Individual
Prefix:
First Name:LAURA
Middle Name:
Last Name:KIMBALL
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 1:22 SARGENT ST
Mailing Address - Street 2:
Mailing Address - City:NORTHFIELD
Mailing Address - State:NH
Mailing Address - Zip Code:03276-4016
Mailing Address - Country:US
Mailing Address - Phone:603-568-7507
Mailing Address - Fax:
Practice Address - Street 1:345 CILLEY RD STE 1
Practice Address - Street 2:
Practice Address - City:MANCHESTER
Practice Address - State:NH
Practice Address - Zip Code:03103-4500
Practice Address - Country:US
Practice Address - Phone:603-350-4935
Practice Address - Fax:800-480-7578
Is Sole Proprietor?:Yes
Enumeration Date:2025-11-20
Last Update Date:2025-11-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes171M00000XOther Service ProvidersCase Manager/Care CoordinatorGroup - Single Specialty