Provider Demographics
NPI:1104670470
Name:VALDERRAMA, KEMBERLEY GICELLA (CNM)
Entity type:Individual
Prefix:
First Name:KEMBERLEY
Middle Name:GICELLA
Last Name:VALDERRAMA
Suffix:
Gender:F
Credentials:CNM
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:425 MARLBORO RD
Mailing Address - Street 2:
Mailing Address - City:ENGLEWOOD
Mailing Address - State:NJ
Mailing Address - Zip Code:07631-1415
Mailing Address - Country:US
Mailing Address - Phone:201-921-5419
Mailing Address - Fax:
Practice Address - Street 1:95 N STATE RT 17 STE 105
Practice Address - Street 2:
Practice Address - City:PARAMUS
Practice Address - State:NJ
Practice Address - Zip Code:07652-2648
Practice Address - Country:US
Practice Address - Phone:201-612-4737
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-04-15
Last Update Date:2024-04-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes367A00000XPhysician Assistants & Advanced Practice Nursing ProvidersAdvanced Practice Midwife
No176B00000XOther Service ProvidersMidwife