Healthcare Provider Details

I. General information

NPI: 1598019671
Provider Name (Legal Business Name): SANDRA MARIE VUILLEMOT REGISTERED NURSE
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 10/29/2012
Last Update Date: 10/29/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5995 SOUTH STREET RD
AUBURN NY
13021-5652
US

IV. Provider business mailing address

5995 SOUTH STREET RD
AUBURN NY
13021-5652
US

V. Phone/Fax

Practice location:
  • Phone: 315-253-0566
  • Fax:
Mailing address:
  • Phone: 315-253-0566
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code163WG0000X
TaxonomyGeneral Practice Registered Nurse
License Number473977-1
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: