Provider Demographics
NPI:1447598008
Name:KOROMA, KADIE
Entity type:Individual
Prefix:
First Name:KADIE
Middle Name:
Last Name:KOROMA
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 1:1501 MORRIS AVE
Mailing Address - Street 2:APT.1
Mailing Address - City:BRONX
Mailing Address - State:NY
Mailing Address - Zip Code:10457-8700
Mailing Address - Country:US
Mailing Address - Phone:347-590-7745
Mailing Address - Fax:
Practice Address - Street 1:1501 MORRIS AVE
Practice Address - Street 2:APT.1
Practice Address - City:BRONX
Practice Address - State:NY
Practice Address - Zip Code:10457-8700
Practice Address - Country:US
Practice Address - Phone:347-590-7745
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2013-01-16
Last Update Date:2013-01-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY311432164W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes164W00000XNursing Service ProvidersLicensed Practical Nurse