Provider Demographics
NPI:1033934666
Name:KEARSE, LANON MONIFA (REGISTERED NURSE)
Entity type:Individual
Prefix:MS
First Name:LANON
Middle Name:MONIFA
Last Name:KEARSE
Suffix:
Gender:F
Credentials:REGISTERED NURSE
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:812 RIVER ST.
Mailing Address - Street 2:
Mailing Address - City:TROY
Mailing Address - State:NY
Mailing Address - Zip Code:12180
Mailing Address - Country:US
Mailing Address - Phone:518-328-1409
Mailing Address - Fax:518-475-6407
Practice Address - Street 1:1 ACADEMY PARK
Practice Address - Street 2:
Practice Address - City:ALBANY
Practice Address - State:NY
Practice Address - Zip Code:12207-1099
Practice Address - Country:US
Practice Address - Phone:518-475-6406
Practice Address - Fax:518-475-6407
Is Sole Proprietor?:Yes
Enumeration Date:2024-11-19
Last Update Date:2024-11-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY523280163WS0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163WS0200XNursing Service ProvidersRegistered NurseSchool