Provider Demographics
NPI:1912582784
Name:KYEREMEH, PHILOMINA O
Entity Type:Individual
Prefix:
First Name:PHILOMINA
Middle Name:O
Last Name:KYEREMEH
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 1:1540 SCARBROUGH CIR SW
Mailing Address - Street 2:
Mailing Address - City:CONCORD
Mailing Address - State:NC
Mailing Address - Zip Code:28025-6725
Mailing Address - Country:US
Mailing Address - Phone:703-615-6049
Mailing Address - Fax:
Practice Address - Street 1:1540 SCARBROUGH CIR SW
Practice Address - Street 2:
Practice Address - City:CONCORD
Practice Address - State:NC
Practice Address - Zip Code:28025-6725
Practice Address - Country:US
Practice Address - Phone:703-615-6049
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-03-13
Last Update Date:2021-03-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC87292251E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251E00000XAgenciesHome Health