MEDICARE: MS. LANON MONIFA KEARSE REGISTERED NURSE

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	163WS0200X	School Registered Nurse	523280	NY

General Provider Information

NPI Number	:	1033934666
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MS. LANON MONIFA KEARSE REGISTERED NURSE

Provider Business Mailing Address
First Line	:	812 RIVER ST.
Second Line	:
City	:	TROY
State	:	NY
Zip	:	12180
Country	:	US
Telephone Number	:	518-328-1409
Fax Number	:	518-475-6407

Provider Business Practice Location Address
First Line	:	1 ACADEMY PARK
Second Line	:
City	:	ALBANY
State	:	NY
Zip	:	12207-1099
Country	:	US
Telephone Number	:	518-475-6406
Fax Number	:	518-475-6407

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	11/19/2024
Last Update Date	:	11/19/2024

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