MEDICARE: MS. ALICE L GROW 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	163WH0200X	Home Health Registered Nurse	424371-1	NY

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	424371-1	OTHER	NY	NYS RN CERTIFICATE
2	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1871617779
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MS. ALICE L GROW RN

Provider Business Mailing Address
First Line	:	1421 ELMIRA RD
Second Line	:
City	:	NEWFIELD
State	:	NY
Zip	:	14867-9263
Country	:	US
Telephone Number	:	607-564-7789
Fax Number	:

Provider Business Practice Location Address
First Line	:	1421 ELMIRA RD
Second Line	:
City	:	NEWFIELD
State	:	NY
Zip	:	14867-9263
Country	:	US
Telephone Number	:	607-564-7789
Fax Number	:

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

Provider Enumeration Date	:	03/17/2007
Last Update Date	:	07/08/2007

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