Provider Demographics
NPI:1457484172
Name:KIEFER, JUNE (MSN CS NPP)
Entity Type:Individual
Prefix:MRS
First Name:JUNE
Middle Name:
Last Name:KIEFER
Suffix:
Gender:F
Credentials:MSN CS NPP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:18 LAKECREST LANE
Mailing Address - Street 2:
Mailing Address - City:RONKONKOMA
Mailing Address - State:NY
Mailing Address - Zip Code:11779
Mailing Address - Country:US
Mailing Address - Phone:631-981-8807
Mailing Address - Fax:631-981-8807
Practice Address - Street 1:18 LAKECREST LANE
Practice Address - Street 2:
Practice Address - City:RONKONKOMA
Practice Address - State:NY
Practice Address - Zip Code:11779
Practice Address - Country:US
Practice Address - Phone:631-981-8807
Practice Address - Fax:631-981-8807
Is Sole Proprietor?:No
Enumeration Date:2007-03-13
Last Update Date:2022-07-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY296463163W00000X
NYF400069363L00000X
NY200250364S00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes364S00000XPhysician Assistants & Advanced Practice Nursing ProvidersClinical Nurse Specialist
No163W00000XNursing Service ProvidersRegistered Nurse
No363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY90V171Medicare ID - Type Unspecified