Individual
KRISTIN E NIMBLEY
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
P.A.-C
Taxonomy
Speciality
Code
Description
License number
State
363AS0400X
Surgical Physician Assistant
Primary
085002814
IL
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
001619727
BCBS OF ILLINOIS
IL
01
—
085002814
STATE LICENSE
IL
Enumeration date
11/20/2007
Last updated
04/07/2022
Update your record
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