Provider Demographics
NPI:1821191933
Name:PERESE, KERIME (NURSE PRACTITIONER)
Entity Type:Individual
Prefix:MS
First Name:KERIME
Middle Name:
Last Name:PERESE
Suffix:
Gender:F
Credentials:NURSE PRACTITIONER
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2697 MAIN ST
Mailing Address - Street 2:PLANNED PARENTHOOD
Mailing Address - City:BUFFALO
Mailing Address - State:NY
Mailing Address - Zip Code:14214
Mailing Address - Country:US
Mailing Address - Phone:716-831-2200
Mailing Address - Fax:716-831-8836
Practice Address - Street 1:2697 MAIN ST
Practice Address - Street 2:PLANNED PARENTHOOD
Practice Address - City:BUFFALO
Practice Address - State:NY
Practice Address - Zip Code:14214
Practice Address - Country:US
Practice Address - Phone:716-831-2200
Practice Address - Fax:716-831-8836
Is Sole Proprietor?:No
Enumeration Date:2006-09-06
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NYF4203181363LW0102X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LW0102XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerWomen's Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
000560232003OtherBCBS
S30031Medicare UPIN
000560232003OtherBCBS