Healthcare Provider Details

I. General information

NPI: 1376733006
Provider Name (Legal Business Name): TAMMY LOUISE FUSCO R.N.
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 07/30/2007
Last Update Date: 07/30/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5240 BROOKHAVEN DR
CLARENCE NY
14031-1612
US

IV. Provider business mailing address

691 MAPLE RD
EAST AURORA NY
14052-1025
US

V. Phone/Fax

Practice location:
  • Phone: 716-759-6707
  • Fax:
Mailing address:
  • Phone: 716-655-6393
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code163WP0200X
TaxonomyPediatric Registered Nurse
License Number369-396-1
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: