Provider Demographics
NPI:1639903164
Name:SEREYKO, KASHA LYN (RN)
Entity type:Individual
Prefix:
First Name:KASHA
Middle Name:LYN
Last Name:SEREYKO
Suffix:
Gender:F
Credentials:RN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:810 ENFIELD RD
Mailing Address - Street 2:
Mailing Address - City:LINCOLN
Mailing Address - State:ME
Mailing Address - Zip Code:04457-4153
Mailing Address - Country:US
Mailing Address - Phone:207-290-4151
Mailing Address - Fax:
Practice Address - Street 1:168 COLLEGE AVE
Practice Address - Street 2:
Practice Address - City:ORONO
Practice Address - State:ME
Practice Address - Zip Code:04473-1513
Practice Address - Country:US
Practice Address - Phone:207-290-4151
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-08-28
Last Update Date:2024-08-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
390200000X
MERN74024163WE0003X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163WE0003XNursing Service ProvidersRegistered NurseEmergency
No390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program