Provider Demographics
NPI:1144755638
Name:KIEMA, JEDIDAH W (REGISTERED NURSE)
Entity type:Individual
Prefix:MRS
First Name:JEDIDAH
Middle Name:W
Last Name:KIEMA
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 1:6387 POMEGRANATE CT
Mailing Address - Street 2:
Mailing Address - City:EASTVALE
Mailing Address - State:CA
Mailing Address - Zip Code:92880-7203
Mailing Address - Country:US
Mailing Address - Phone:626-488-9787
Mailing Address - Fax:
Practice Address - Street 1:6387 POMEGRANATE CT
Practice Address - Street 2:
Practice Address - City:EASTVALE
Practice Address - State:CA
Practice Address - Zip Code:92880-7203
Practice Address - Country:US
Practice Address - Phone:626-488-9787
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2017-04-22
Last Update Date:2017-04-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA504041163WA2000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163WA2000XNursing Service ProvidersRegistered NurseAdministrator