Provider Demographics
NPI:1427596253
Name:KASEMSAN-SOWUNMI, KORAKOTE (RN, BSN)
Entity Type:Individual
Prefix:
First Name:KORAKOTE
Middle Name:
Last Name:KASEMSAN-SOWUNMI
Suffix:
Gender:F
Credentials:RN, BSN
Other - Prefix:
Other - First Name:KORAKOTE
Other - Middle Name:
Other - Last Name:KASEMSAN
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:1320 CONEY ISLAND AVE APT B3
Mailing Address - Street 2:
Mailing Address - City:BROOKLYN
Mailing Address - State:NY
Mailing Address - Zip Code:11230-3548
Mailing Address - Country:US
Mailing Address - Phone:646-785-7775
Mailing Address - Fax:
Practice Address - Street 1:1320 CONEY ISLAND AVE APT B3
Practice Address - Street 2:
Practice Address - City:BROOKLYN
Practice Address - State:NY
Practice Address - Zip Code:11230-3548
Practice Address - Country:US
Practice Address - Phone:646-785-7775
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2017-01-31
Last Update Date:2017-01-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY708256-1163W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163W00000XNursing Service ProvidersRegistered Nurse