MEDICARE: MRS. CHRISTINE ANN DECIRCE 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	290526	NY
2	163W00000X	Registered Nurse	084601	CT

General Provider Information

NPI Number	:	1750518064
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MRS. CHRISTINE ANN DECIRCE RN

Provider Business Mailing Address
First Line	:	6304 CARRIER PARKWAY
Second Line	:	TR5
City	:	EAST SYRACUSE
State	:	NY
Zip	:	13057
Country	:	US
Telephone Number	:	315-432-6369
Fax Number	:	860-998-0720

Provider Business Practice Location Address
First Line	:	6304 THOMPSON ROAD
Second Line	:
City	:	SYRACUSE
State	:	NY
Zip	:	13221
Country	:	US
Telephone Number	:	315-432-6369
Fax Number	:	860-998-0720

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

Provider Enumeration Date	:	06/12/2009
Last Update Date	:	06/12/2009

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