Healthcare Provider Details

I. General information

NPI: 1124851399
Provider Name (Legal Business Name): KATHERINE CUERO LPN
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/23/2024
Last Update Date: 08/23/2024
Certification Date: 08/23/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

265 BROADHOLLOW RD STE 200
MELVILLE NY
11747-4833
US

IV. Provider business mailing address

159 NEWMAN ST
BRENTWOOD NY
11717-6301
US

V. Phone/Fax

Practice location:
  • Phone: 631-815-2735
  • Fax:
Mailing address:
  • Phone: 631-994-4864
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code164W00000X
TaxonomyLicensed Practical Nurse
License Number341604-01
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: