MEDICARE: GLORIA CHRISTINE WENTWORTH REGISTERED NURSE

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	352269-1	NY

General Provider Information

NPI Number	:	1417223827
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	GLORIA CHRISTINE WENTWORTH REGISTERED NURSE

Provider Business Mailing Address
First Line	:	46 WILSON AVE
Second Line	:
City	:	SOUTH GLENS FALLS
State	:	NY
Zip	:	12803-5137
Country	:	US
Telephone Number	:	518-307-1887
Fax Number	:

Provider Business Practice Location Address
First Line	:	46 WILSON AVE
Second Line	:
City	:	SOUTH GLENS FALLS
State	:	NY
Zip	:	12803-5137
Country	:	US
Telephone Number	:	518-307-1887
Fax Number	:

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

Provider Enumeration Date	:	03/29/2012
Last Update Date	:	03/29/2012

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