MEDICARE: VINCINE ANTONIA FALLICA R.N.

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	163W00000X	Registered Nurse	535322-1	NY

General Provider Information

NPI Number	:	1376815217
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	VINCINE ANTONIA FALLICA R.N.

Provider Business Mailing Address
First Line	:	129 MAIN ST
Second Line	:	APT 6
City	:	SARANAC LAKE
State	:	NY
Zip	:	12983-1756
Country	:	US
Telephone Number	:	518-637-7582
Fax Number	:

Provider Business Practice Location Address
First Line	:	129 MAIN ST
Second Line	:	APT 6
City	:	SARANAC LAKE
State	:	NY
Zip	:	12983-1756
Country	:	US
Telephone Number	:	518-637-7582
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	02/08/2012
Last Update Date	:	02/08/2012

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