MEDICARE: MRS. CRYSTAL BATEMAN NP

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	363LP0200X	Pediatric Nurse Practitioner	381346	NY

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	NP0729	OTHER	NY	PREFERRED CARE

General Provider Information

NPI Number	:	1972609709
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MRS. CRYSTAL BATEMAN NP

Provider Business Mailing Address
First Line	:	4415 BUFFALO RD
Second Line	:	SUITE 1B
City	:	NORTH CHILI
State	:	NY
Zip	:	14514-1024
Country	:	US
Telephone Number	:	585-594-9254
Fax Number	:	585-594-9233

Provider Business Practice Location Address
First Line	:	4415 BUFFALO RD
Second Line	:	SUITE 1B
City	:	NORTH CHILI
State	:	NY
Zip	:	14514-1024
Country	:	US
Telephone Number	:	585-594-9254
Fax Number	:	585-594-9233

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

Provider Enumeration Date	:	09/16/2006
Last Update Date	:	04/06/2015

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