Healthcare Provider Details

I. General information

NPI: 1598097503
Provider Name (Legal Business Name): NANCY V. HARPER RN REGISTERED NURSE
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 02/02/2010
Last Update Date: 02/02/2010
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

11752 HUNTS CORNERS ROAD
CLYDE NY
14433
US

IV. Provider business mailing address

11752 HUNTS CORNERS ROAD
CLYDE NY
14433
US

V. Phone/Fax

Practice location:
  • Phone: 315-923-1229
  • Fax: 315-879-7042
Mailing address:
  • Phone: 315-923-1229
  • Fax: 315-879-7042

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code163W00000X
TaxonomyRegistered Nurse
License Number308630
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: