Provider Demographics
NPI:1871577502
Name:KICZA-KLASMIER, KIM MICHELLE (ARNP)
Entity type:Individual
Prefix:MRS
First Name:KIM
Middle Name:MICHELLE
Last Name:KICZA-KLASMIER
Suffix:
Gender:F
Credentials:ARNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:105 ROSECLIFF LN
Mailing Address - Street 2:
Mailing Address - City:MANCHESTER
Mailing Address - State:NH
Mailing Address - Zip Code:03109-5958
Mailing Address - Country:US
Mailing Address - Phone:603-669-8313
Mailing Address - Fax:
Practice Address - Street 1:195 MCGREGOR ST
Practice Address - Street 2:THIRD FLOOR
Practice Address - City:MANCHESTER
Practice Address - State:NH
Practice Address - Zip Code:03102-3748
Practice Address - Country:US
Practice Address - Phone:603-663-8718
Practice Address - Fax:
Is Sole Proprietor?:Not Answered
Enumeration Date:2005-12-06
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NH0340992303363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
Provider Identifiers
StateIdentifier IDID TypeIssuer
NHNP1649Medicare ID - Type Unspecified
NHP24189Medicare UPIN