Basic Information
| Provider Information | |||||||||
| NPI: | 1871867598 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | NELSON | ||||||||
| FirstName: | KIMBERLY | ||||||||
| MiddleName: | BERNICE | ||||||||
| NamePrefix: | MS. | ||||||||
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| Credential: | MS, MBA, RN | ||||||||
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| Mailing Information | |||||||||
| Address1: | 1508 MOUNT VERNON ST | ||||||||
| Address2: | #2F | ||||||||
| City: | PHILADELPHIA | ||||||||
| State: | PA | ||||||||
| PostalCode: | 191303449 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2676392715 | ||||||||
| FaxNumber: | |||||||||
| Practice Location | |||||||||
| Address1: | 1930 S BROAD ST | ||||||||
| Address2: | |||||||||
| City: | PHILADELPHIA | ||||||||
| State: | PA | ||||||||
| PostalCode: | 191452328 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2153394563 | ||||||||
| FaxNumber: | |||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 02/27/2012 | ||||||||
| LastUpdateDate: | 02/27/2012 | ||||||||
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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 | 163W00000X | R157787 | MD | N | Nursing Service Providers | Registered Nurse | 163WC1600X | RN601348 | PA | Y | Nursing Service Providers | Registered Nurse | Continuing Education/Staff Development |
No ID Information.