Healthcare Provider Details

I. General information

NPI: 1821191933
Provider Name (Legal Business Name): KERIME PERESE NURSE PRACTITIONER
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/06/2006
Last Update Date: 05/15/2024
Certification Date: 05/15/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

191 N MAIN ST
WELLSVILLE NY
14895-1150
US

IV. Provider business mailing address

191 N MAIN ST
WELLSVILLE NY
14895-1150
US

V. Phone/Fax

Practice location:
  • Phone: 585-593-1199
  • Fax:
Mailing address:
  • Phone: 585-593-1100
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number338241
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: