1902694714 NPI number — KIMBERLY MAUREEN VANOVER-BARDO FNP

Table of Contents

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1902694714 NPI number — KIMBERLY MAUREEN VANOVER-BARDO FNP

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
VANOVER-BARDO
Provider First Name:
KIMBERLY
Provider Middle Name:
MAUREEN
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
FNP
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
KREITZER
Provider Other First Name:
KIMBERLY
Provider Other Middle Name:
M
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
RN
Provider Other Last Name Type Code:
1

NPI Number Information

NPI Number:
1902694714
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
05/01/2025
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
17509 COUNTY ROAD 25A
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
WAPAKONETA
Provider Business Mailing Address State Name:
OH
Provider Business Mailing Address Postal Code:
45895-7748
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
419-236-1922
Provider Business Mailing Address Fax Number:

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
17509 COUNTY ROAD 25A
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
WAPAKONETA
Provider Business Practice Location Address State Name:
OH
Provider Business Practice Location Address Postal Code:
45895-7748
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
419-236-1922
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
04/30/2025

Additional Information

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 363LF0000X , with the licence number:  0039062 , registered in the state of OH ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)





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