Provider Demographics
NPI:1699396226
Name:DURDAK, KERI ANN (LPN)
Entity Type:Individual
Prefix:MRS
First Name:KERI
Middle Name:ANN
Last Name:DURDAK
Suffix:
Gender:F
Credentials:LPN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:400 BABBITT RD
Mailing Address - Street 2:
Mailing Address - City:EUCLID
Mailing Address - State:OH
Mailing Address - Zip Code:44123-1644
Mailing Address - Country:US
Mailing Address - Phone:216-732-0000
Mailing Address - Fax:
Practice Address - Street 1:400 BABBITT RD
Practice Address - Street 2:
Practice Address - City:EUCLID
Practice Address - State:OH
Practice Address - Zip Code:44123-1644
Practice Address - Country:US
Practice Address - Phone:216-733-0000
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-05-05
Last Update Date:2020-05-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHPN.123763-MEDS164W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes164W00000XNursing Service ProvidersLicensed Practical Nurse