Provider Demographics
NPI:1871277418
Name:KERILA, DAWN DOLORES (RN)
Entity type:Individual
Prefix:
First Name:DAWN
Middle Name:DOLORES
Last Name:KERILA
Suffix:
Gender:F
Credentials:RN
Other - Prefix:
Other - First Name:DAWN
Other - Middle Name:
Other - Last Name:KERILA
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:
Mailing Address - Street 1:914 DOUGLAS DR
Mailing Address - Street 2:
Mailing Address - City:ENDWELL
Mailing Address - State:NY
Mailing Address - Zip Code:13760-1938
Mailing Address - Country:US
Mailing Address - Phone:607-221-6091
Mailing Address - Fax:
Practice Address - Street 1:914 DOUGLAS DR
Practice Address - Street 2:
Practice Address - City:ENDWELL
Practice Address - State:NY
Practice Address - Zip Code:13760-1938
Practice Address - Country:US
Practice Address - Phone:607-221-6091
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2023-06-14
Last Update Date:2023-06-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY764233163W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes163W00000XNursing Service ProvidersRegistered NurseGroup - Single Specialty