Provider Demographics
NPI:1336780733
Name:EXANTUS, KERLINE
Entity Type:Individual
Prefix:
First Name:KERLINE
Middle Name:
Last Name:EXANTUS
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 1:1 ADDISON AVE
Mailing Address - Street 2:
Mailing Address - City:LYNN
Mailing Address - State:MA
Mailing Address - Zip Code:01902-1131
Mailing Address - Country:US
Mailing Address - Phone:781-823-9706
Mailing Address - Fax:
Practice Address - Street 1:1 ADDISON AVE
Practice Address - Street 2:
Practice Address - City:LYNN
Practice Address - State:MA
Practice Address - Zip Code:01902-1131
Practice Address - Country:US
Practice Address - Phone:781-823-9706
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2019-10-07
Last Update Date:2019-10-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes374U00000XNursing Service Related ProvidersHome Health Aide