Healthcare Provider Details

I. General information

NPI: 1780399113
Provider Name (Legal Business Name): KACIE C GIKONYO RN
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 01/19/2023
Last Update Date: 01/19/2023
Certification Date: 01/19/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

7289 WARD RD
PARMA OH
44134-5486
US

IV. Provider business mailing address

7289 WARD RD
PARMA OH
44134-5486
US

V. Phone/Fax

Practice location:
  • Phone: 330-620-2176
  • Fax:
Mailing address:
  • Phone: 330-620-2176
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code163WG0600X
TaxonomyGerontology Registered Nurse
License NumberRN.375880
License Number StateOH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: