Provider Demographics
NPI:1407255946
Name:KARERERWA, ILDEGONDE
Entity Type:Individual
Prefix:
First Name:ILDEGONDE
Middle Name:
Last Name:KARERERWA
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:194 BIRCHWOOD RD
Mailing Address - Street 2:
Mailing Address - City:CORAM
Mailing Address - State:NY
Mailing Address - Zip Code:11727-3646
Mailing Address - Country:US
Mailing Address - Phone:330-962-6092
Mailing Address - Fax:
Practice Address - Street 1:194 BIRCHWOOD RD
Practice Address - Street 2:
Practice Address - City:CORAM
Practice Address - State:NY
Practice Address - Zip Code:11727-3646
Practice Address - Country:US
Practice Address - Phone:330-962-6092
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2014-08-21
Last Update Date:2014-08-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY685857163W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163W00000XNursing Service ProvidersRegistered Nurse