Provider Demographics
NPI:1023828043
Name:KIMORI, EVERLYNE KEMUNTO
Entity type:Individual
Prefix:
First Name:EVERLYNE
Middle Name:KEMUNTO
Last Name:KIMORI
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1674 AUGUST DR
Mailing Address - Street 2:
Mailing Address - City:SHAKOPEE
Mailing Address - State:MN
Mailing Address - Zip Code:55379-7740
Mailing Address - Country:US
Mailing Address - Phone:651-353-5861
Mailing Address - Fax:
Practice Address - Street 1:1674 AUGUST DR
Practice Address - Street 2:
Practice Address - City:SHAKOPEE
Practice Address - State:MN
Practice Address - Zip Code:55379-7740
Practice Address - Country:US
Practice Address - Phone:651-353-5861
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2025-01-11
Last Update Date:2025-01-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN2429362163W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163W00000XNursing Service ProvidersRegistered Nurse