Provider Demographics
NPI:1366744278
Name:KEROBO, SUNDAY (RN)
Entity type:Individual
Prefix:
First Name:SUNDAY
Middle Name:
Last Name:KEROBO
Suffix:
Gender:M
Credentials:RN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 250365
Mailing Address - Street 2:
Mailing Address - City:MILWAUKEE
Mailing Address - State:WI
Mailing Address - Zip Code:53225-6504
Mailing Address - Country:US
Mailing Address - Phone:414-350-4837
Mailing Address - Fax:414-377-0528
Practice Address - Street 1:9809 W FOUNTAIN AVE
Practice Address - Street 2:
Practice Address - City:MILWAUKEE
Practice Address - State:WI
Practice Address - Zip Code:53224
Practice Address - Country:US
Practice Address - Phone:414-350-4837
Practice Address - Fax:414-377-0528
Is Sole Proprietor?:Yes
Enumeration Date:2010-11-29
Last Update Date:2013-07-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI167833-30163W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163W00000XNursing Service ProvidersRegistered Nurse