Provider Demographics
NPI:1851149264
Name:NERO, KESIA SUE
Entity type:Individual
Prefix:
First Name:KESIA
Middle Name:SUE
Last Name:NERO
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 1:28680 BEECHWOOD AVE
Mailing Address - Street 2:
Mailing Address - City:FLAT ROCK
Mailing Address - State:MI
Mailing Address - Zip Code:48134-9700
Mailing Address - Country:US
Mailing Address - Phone:313-682-0293
Mailing Address - Fax:
Practice Address - Street 1:28680 BEECHWOOD AVE
Practice Address - Street 2:
Practice Address - City:FLAT ROCK
Practice Address - State:MI
Practice Address - Zip Code:48134-9700
Practice Address - Country:US
Practice Address - Phone:313-682-0293
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-05-09
Last Update Date:2024-05-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI7501008160225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist