Provider Demographics
NPI:1710747092
Name:LUMSDEN, KERISHA
Entity Type:Individual
Prefix:
First Name:KERISHA
Middle Name:
Last Name:LUMSDEN
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 1:3 BOULDER CT
Mailing Address - Street 2:
Mailing Address - City:HIGHLAND MILLS
Mailing Address - State:NY
Mailing Address - Zip Code:10930-6807
Mailing Address - Country:US
Mailing Address - Phone:203-414-4806
Mailing Address - Fax:
Practice Address - Street 1:3 BOULDER CT
Practice Address - Street 2:
Practice Address - City:HIGHLAND MILLS
Practice Address - State:NY
Practice Address - Zip Code:10930-6807
Practice Address - Country:US
Practice Address - Phone:203-414-4806
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-03-21
Last Update Date:2024-03-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY615279163W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163W00000XNursing Service ProvidersRegistered Nurse