Individual
BRIAN JOHN KEREKY
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
LPN
Contact information
Practice address
4017 LAKE RD LOT 28, CONNEAUT, OH 44030-2946
(440) 593-3919
Mailing address
4017 LAKE RD LOT 28, CONNEAUT, OH 44030-2946
(440) 593-3919
Taxonomy
Speciality
Code
Description
License number
State
164W00000X
Licensed Practical Nurse
Primary
PN134320-M-IV
OH
Other
Enumeration date
08/09/2010
Last updated
08/09/2010
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