Provider Demographics
NPI:1548690589
Name:KLIMOWICZ, KIMBERLEY ANN (MSN RN NPP)
Entity type:Individual
Prefix:
First Name:KIMBERLEY
Middle Name:ANN
Last Name:KLIMOWICZ
Suffix:
Gender:F
Credentials:MSN RN NPP
Other - Prefix:
Other - First Name:KIMBERLEY
Other - Middle Name:ANN
Other - Last Name:PIENIAZEK
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:BSN RN
Mailing Address - Street 1:719 HARRISON ST
Mailing Address - Street 2:
Mailing Address - City:SYRACUSE
Mailing Address - State:NY
Mailing Address - Zip Code:13210-2695
Mailing Address - Country:US
Mailing Address - Phone:315-464-3265
Mailing Address - Fax:315-464-3282
Practice Address - Street 1:719 HARRISON ST
Practice Address - Street 2:
Practice Address - City:SYRACUSE
Practice Address - State:NY
Practice Address - Zip Code:13210-2695
Practice Address - Country:US
Practice Address - Phone:315-464-3265
Practice Address - Fax:315-464-3282
Is Sole Proprietor?:No
Enumeration Date:2013-11-12
Last Update Date:2024-08-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY405851363LP0808X
NY649130163W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP0808XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPsychiatric/Mental Health
No163W00000XNursing Service ProvidersRegistered Nurse