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NPI Code Detail

MEDICARE: PATRICIA HILLS PNP

MEDICARE:   PATRICIA  HILLS  PNP
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
1163W00000XRegistered Nurse236732NY
2363LP0200XPediatric Nurse PractitionerF380369NY

General Provider Information

NPI Number : 1760716104
Entity Type Code : Individual
Provider Name (Legal Business Name) : PATRICIA HILLS PNP
Provider Business Mailing Address
First Line : 7755 ROUTE 83
Second Line : PINE VALLEY CENTRAL SCHOOL
City : SOUTH DAYTON
State : NY
Zip : 14138-9633
Country : US
Telephone Number : 716-988-3291
Fax Number :
Provider Business Practice Location Address
First Line : 7755 ROUTE 83
Second Line : PINE VALLEY CENTRAL HIGH SCHOOL
City : SOUTH DAYTON
State : NY
Zip : 14138-9633
Country : US
Telephone Number : 716-988-3291
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 10/01/2009
Last Update Date : 03/06/2010

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