Provider Demographics
NPI:1750128989
Name:KEGEGE, EVERLYNE DIONA
Entity type:Individual
Prefix:MISS
First Name:EVERLYNE
Middle Name:DIONA
Last Name:KEGEGE
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 1:8525 152ND LN NW
Mailing Address - Street 2:
Mailing Address - City:RAMSEY
Mailing Address - State:MN
Mailing Address - Zip Code:55303-7115
Mailing Address - Country:US
Mailing Address - Phone:832-836-0977
Mailing Address - Fax:
Practice Address - Street 1:8525 152ND LN NW
Practice Address - Street 2:
Practice Address - City:RAMSEY
Practice Address - State:MN
Practice Address - Zip Code:55303-7115
Practice Address - Country:US
Practice Address - Phone:832-836-0977
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-07-15
Last Update Date:2024-07-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN2526190163W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes163W00000XNursing Service ProvidersRegistered NurseGroup - Single Specialty