Provider Demographics
NPI:1780399113
Name:GIKONYO, KACIE C (RN)
Entity type:Individual
Prefix:
First Name:KACIE
Middle Name:C
Last Name:GIKONYO
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 1:7289 WARD RD
Mailing Address - Street 2:
Mailing Address - City:PARMA
Mailing Address - State:OH
Mailing Address - Zip Code:44134-5486
Mailing Address - Country:US
Mailing Address - Phone:330-620-2176
Mailing Address - Fax:
Practice Address - Street 1:7289 WARD RD
Practice Address - Street 2:
Practice Address - City:PARMA
Practice Address - State:OH
Practice Address - Zip Code:44134-5486
Practice Address - Country:US
Practice Address - Phone:330-620-2176
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-01-19
Last Update Date:2023-01-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHRN.375880163WG0600X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163WG0600XNursing Service ProvidersRegistered NurseGerontology