Provider Demographics
NPI:1760727226
Name:KERINS, MONA LORNA (REGISTERED NURSE)
Entity Type:Individual
Prefix:MRS
First Name:MONA
Middle Name:LORNA
Last Name:KERINS
Suffix:
Gender:F
Credentials:REGISTERED NURSE
Other - Prefix:MRS
Other - First Name:MONA
Other - Middle Name:LORNA
Other - Last Name:KERINS
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:REGISTERED NURSE
Mailing Address - Street 1:300 CENTER DR
Mailing Address - Street 2:
Mailing Address - City:RIVERHEAD
Mailing Address - State:NY
Mailing Address - Zip Code:11901-3393
Mailing Address - Country:US
Mailing Address - Phone:631-852-2680
Mailing Address - Fax:631-852-3827
Practice Address - Street 1:300 CENTER DR
Practice Address - Street 2:
Practice Address - City:RIVERHEAD
Practice Address - State:NY
Practice Address - Zip Code:11901-3393
Practice Address - Country:US
Practice Address - Phone:631-852-2680
Practice Address - Fax:631-852-3827
Is Sole Proprietor?:No
Enumeration Date:2012-12-10
Last Update Date:2012-12-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY1891991163WA0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163WA0400XNursing Service ProvidersRegistered NurseAddiction (Substance Use Disorder)