Provider Demographics
NPI:1861758872
Name:BOYER, KIMBERLY ANN (LPN)
Entity type:Individual
Prefix:MRS
First Name:KIMBERLY
Middle Name:ANN
Last Name:BOYER
Suffix:
Gender:F
Credentials:LPN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:22401 CYGNET RD
Mailing Address - Street 2:
Mailing Address - City:CUSTAR
Mailing Address - State:OH
Mailing Address - Zip Code:43511-9741
Mailing Address - Country:US
Mailing Address - Phone:419-672-8279
Mailing Address - Fax:
Practice Address - Street 1:22401 CYGNET RD
Practice Address - Street 2:
Practice Address - City:CUSTAR
Practice Address - State:OH
Practice Address - Zip Code:43511-9741
Practice Address - Country:US
Practice Address - Phone:419-672-8279
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2012-04-03
Last Update Date:2012-04-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHPN 130373164W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes164W00000XNursing Service ProvidersLicensed Practical Nurse