Provider Demographics
NPI:1912163668
Name:KERSHNER, JUNE (NP)
Entity Type:Individual
Prefix:
First Name:JUNE
Middle Name:
Last Name:KERSHNER
Suffix:
Gender:F
Credentials:NP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2000 CIBOLA LOOP
Mailing Address - Street 2:
Mailing Address - City:MILAN
Mailing Address - State:NM
Mailing Address - Zip Code:87021
Mailing Address - Country:US
Mailing Address - Phone:505-285-4974
Mailing Address - Fax:
Practice Address - Street 1:2000 CIBOLA LOOP
Practice Address - Street 2:
Practice Address - City:MILAN
Practice Address - State:NM
Practice Address - Zip Code:87021
Practice Address - Country:US
Practice Address - Phone:505-285-4974
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2008-08-01
Last Update Date:2008-08-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NMR33270363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily