Healthcare Provider Details

I. General information

NPI: 1184787335
Provider Name (Legal Business Name): NORMAN ANDREW STARKWEATHER RN
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 12/19/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5433 BORGASE LN
CLAY NY
13041-8916
US

IV. Provider business mailing address

5433 BORGASE LN
CLAY NY
13041-8916
US

V. Phone/Fax

Practice location:
  • Phone: 315-751-2195
  • Fax:
Mailing address:
  • Phone: 315-751-2195
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code163WE0003X
TaxonomyEmergency Registered Nurse
License Number523781
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: