Healthcare Provider Details

I. General information

NPI: 1215198064
Provider Name (Legal Business Name): CAROL D. NIGHTENGALE F.N.P.
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 06/24/2008
Last Update Date: 07/08/2014
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

29 ACADEMY STREET AFTON SCHOOL
AFTON NY
13730
US

IV. Provider business mailing address

29 ACADEMY ST AFTON SCHOOL
AFTON NY
13730
US

V. Phone/Fax

Practice location:
  • Phone: 607-639-8224
  • Fax: 607-639-8257
Mailing address:
  • Phone: 307-639-8224
  • Fax: 607-639-8257

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number332798
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: