MEDICARE: MRS. JANET LEE OTTAVIANO RN

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	386997-1	NY

General Provider Information

NPI Number	:	1578795050
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MRS. JANET LEE OTTAVIANO RN

Provider Business Mailing Address
First Line	:	10740 ROUTE 240
Second Line	:
City	:	WEST VALLEY
State	:	NY
Zip	:	14171-9796
Country	:	US
Telephone Number	:	716-942-3980
Fax Number	:

Provider Business Practice Location Address
First Line	:	10740 ROUTE 240
Second Line	:
City	:	WEST VALLEY
State	:	NY
Zip	:	14171-9796
Country	:	US
Telephone Number	:	716-942-3980
Fax Number	:

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

Provider Enumeration Date	:	08/17/2009
Last Update Date	:	08/17/2009

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