Provider Demographics
NPI:1508397829
Name:CHERUIYOT, IRENE SARAH EBOLE (REGISTERED NURSE)
Entity Type:Individual
Prefix:
First Name:IRENE
Middle Name:SARAH EBOLE
Last Name:CHERUIYOT
Suffix:
Gender:F
Credentials:REGISTERED NURSE
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:32 ALAN CT
Mailing Address - Street 2:APT. 318
Mailing Address - City:FLORENCE
Mailing Address - State:KY
Mailing Address - Zip Code:41042-5359
Mailing Address - Country:US
Mailing Address - Phone:859-445-8406
Mailing Address - Fax:
Practice Address - Street 1:32 ALAN CT
Practice Address - Street 2:APT. 318
Practice Address - City:FLORENCE
Practice Address - State:KY
Practice Address - Zip Code:41042-5359
Practice Address - Country:US
Practice Address - Phone:859-445-8406
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2017-03-27
Last Update Date:2017-03-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHRN.431985163W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163W00000XNursing Service ProvidersRegistered Nurse