Provider Demographics
NPI:1992718076
Name:SUREAU, KIMBERLY ANNE (NP)
Entity type:Individual
Prefix:MS
First Name:KIMBERLY
Middle Name:ANNE
Last Name:SUREAU
Suffix:
Gender:F
Credentials:NP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:545 1ST AVE
Mailing Address - Street 2:C-124
Mailing Address - City:NEW YORK
Mailing Address - State:NY
Mailing Address - Zip Code:10016-6401
Mailing Address - Country:US
Mailing Address - Phone:212-263-7411
Mailing Address - Fax:
Practice Address - Street 1:462 1ST AVE
Practice Address - Street 2:10S1
Practice Address - City:NEW YORK
Practice Address - State:NY
Practice Address - Zip Code:10016-9196
Practice Address - Country:US
Practice Address - Phone:212-562-2227
Practice Address - Fax:212-562-2991
Is Sole Proprietor?:No
Enumeration Date:2006-08-13
Last Update Date:2022-09-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NYF430278363LA2100X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LA2100XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerAcute Care