MEDICARE: DONNA KAY STOUT RN BS

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	280196-1	NY

General Provider Information

NPI Number	:	1942570270
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DONNA KAY STOUT RN BS

Provider Business Mailing Address
First Line	:	478 BURLINGHAM RD
Second Line	:
City	:	BLOOMINGBURG
State	:	NY
Zip	:	12721-5011
Country	:	US
Telephone Number	:	845-733-5469
Fax Number	:

Provider Business Practice Location Address
First Line	:	141 UNION ST
Second Line	:
City	:	MONTGOMERY
State	:	NY
Zip	:	12549-1316
Country	:	US
Telephone Number	:	845-457-2400
Fax Number	:

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

Provider Enumeration Date	:	01/03/2012
Last Update Date	:	01/03/2012

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