Basic Information
| Provider Information | |||||||||
| NPI: | 1003295056 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | LUDWIG | ||||||||
| FirstName: | KIMBERLY | ||||||||
| MiddleName: | JEAN | ||||||||
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| Credential: | LPN | ||||||||
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| Mailing Information | |||||||||
| Address1: | 2214 NW 2ND ST | ||||||||
| Address2: | |||||||||
| City: | ANKENY | ||||||||
| State: | IA | ||||||||
| PostalCode: | 500231304 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5154906130 | ||||||||
| FaxNumber: | |||||||||
| Practice Location | |||||||||
| Address1: | 1002 W WASHINGTON AVE | ||||||||
| Address2: | |||||||||
| City: | POLK CITY | ||||||||
| State: | IA | ||||||||
| PostalCode: | 502262132 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5154906130 | ||||||||
| FaxNumber: | |||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 05/22/2015 | ||||||||
| LastUpdateDate: | 05/22/2015 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 164W00000X | P52457 | IA | Y | Nursing Service Providers | Licensed Practical Nurse |
No ID Information.