Provider Demographics
NPI:1518431048
Name:IKE, KERRIE JEAN (RN)
Entity Type:Individual
Prefix:
First Name:KERRIE
Middle Name:JEAN
Last Name:IKE
Suffix:
Gender:F
Credentials:RN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 3236
Mailing Address - Street 2:
Mailing Address - City:WOBURN
Mailing Address - State:MA
Mailing Address - Zip Code:01888-3236
Mailing Address - Country:US
Mailing Address - Phone:808-368-5783
Mailing Address - Fax:
Practice Address - Street 1:231 MILL ST
Practice Address - Street 2:
Practice Address - City:BURLINGTON
Practice Address - State:MA
Practice Address - Zip Code:01803-1849
Practice Address - Country:US
Practice Address - Phone:808-368-5783
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2019-01-17
Last Update Date:2021-07-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MARN2284582163W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163W00000XNursing Service ProvidersRegistered Nurse