Provider Demographics
NPI:1861221459
Name:CHEM, KEVIN NIMITZ (RN)
Entity type:Individual
Prefix:
First Name:KEVIN
Middle Name:NIMITZ
Last Name:CHEM
Suffix:
Gender:M
Credentials:RN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:805 MARTIN LUTHER KING JR BLVD APT 8
Mailing Address - Street 2:
Mailing Address - City:MACON
Mailing Address - State:GA
Mailing Address - Zip Code:31201-3292
Mailing Address - Country:US
Mailing Address - Phone:952-686-8808
Mailing Address - Fax:
Practice Address - Street 1:805 MLK BLVD APT 8
Practice Address - Street 2:
Practice Address - City:MACON
Practice Address - State:GA
Practice Address - Zip Code:31201-3292
Practice Address - Country:US
Practice Address - Phone:952-686-8808
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-07-31
Last Update Date:2024-07-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN2471128163W00000X
GARN312252163W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163W00000XNursing Service ProvidersRegistered Nurse