Provider Demographics
NPI:1902037062
Name:DEMONTE, KIM C (LPN)
Entity Type:Individual
Prefix:MRS
First Name:KIM
Middle Name:C
Last Name:DEMONTE
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 1:1 WINDWARD CT
Mailing Address - Street 2:
Mailing Address - City:DIX HILLS
Mailing Address - State:NY
Mailing Address - Zip Code:11746-6660
Mailing Address - Country:US
Mailing Address - Phone:631-491-6818
Mailing Address - Fax:631-491-0530
Practice Address - Street 1:1 WINDWARD CT
Practice Address - Street 2:
Practice Address - City:DIX HILLS
Practice Address - State:NY
Practice Address - Zip Code:11746-6660
Practice Address - Country:US
Practice Address - Phone:631-491-6818
Practice Address - Fax:631-491-0530
Is Sole Proprietor?:Yes
Enumeration Date:2009-08-06
Last Update Date:2009-08-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY119239164W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes164W00000XNursing Service ProvidersLicensed Practical Nurse