Healthcare Provider Details

I. General information

NPI: 1710636436
Provider Name (Legal Business Name): CIEARA KERR RN
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/21/2022
Last Update Date: 03/21/2022
Certification Date: 03/21/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

17 HAMILTON AVE
MONTICELLO NY
12701-1319
US

IV. Provider business mailing address

7 ELK DR
MONTICELLO NY
12701-5204
US

V. Phone/Fax

Practice location:
  • Phone: 845-794-8080
  • Fax:
Mailing address:
  • Phone: 845-423-1444
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code163W00000X
TaxonomyRegistered Nurse
License Number808526
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: