Healthcare Provider Details

I. General information

NPI: 1427715267
Provider Name (Legal Business Name): KERRI BOEMIO FNP
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 11/29/2021
Last Update Date: 11/29/2021
Certification Date: 11/26/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

17 CENTRAL AVE
ISLAND HEIGHTS NJ
08732-7714
US

IV. Provider business mailing address

PO BOX 779
ISLAND HEIGHTS NJ
08732-0779
US

V. Phone/Fax

Practice location:
  • Phone: 908-783-5143
  • Fax:
Mailing address:
  • Phone: 908-783-5143
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number26NJ01224300
License Number StateNJ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: