Provider Demographics
NPI:1710394952
Name:ZEHR-RUNKLES, KENDRA
Entity Type:Individual
Prefix:
First Name:KENDRA
Middle Name:
Last Name:ZEHR-RUNKLES
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:36 WILNA AVENUE
Mailing Address - Street 2:
Mailing Address - City:DEFERIET
Mailing Address - State:NY
Mailing Address - Zip Code:13628
Mailing Address - Country:US
Mailing Address - Phone:315-519-1139
Mailing Address - Fax:
Practice Address - Street 1:36 WILNA AVENUE
Practice Address - Street 2:
Practice Address - City:DEFERIET
Practice Address - State:NY
Practice Address - Zip Code:13628
Practice Address - Country:US
Practice Address - Phone:315-519-1139
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2014-07-21
Last Update Date:2014-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY309644-1164W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes164W00000XNursing Service ProvidersLicensed Practical Nurse