Healthcare Provider Details

I. General information

NPI: 1194095802
Provider Name (Legal Business Name): KELLY ANNE CIRIGLIANO RN
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 01/11/2012
Last Update Date: 01/11/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

18 JULIAND STREET BAINBRIDGE-GUILFORD CENTRAL SCHOOL DISTRICT
BAINBRIDGE NY
13733-1097
US

IV. Provider business mailing address

18 JULIAND BAINBRIDGE-GUILFORD CENTRAL SCHOOL DISTRICT
BAINBRIDGE NY
13733-1097
US

V. Phone/Fax

Practice location:
  • Phone: 607-967-6313
  • Fax: 607-967-4231
Mailing address:
  • Phone: 607-967-6313
  • Fax: 607-967-4231

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code163W00000X
TaxonomyRegistered Nurse
License Number602994
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: