Healthcare Provider Details

I. General information

NPI: 1497238794
Provider Name (Legal Business Name): KATRINA ERIKA VACARELLI LPN
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 09/12/2018
Last Update Date: 09/12/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

83 PARK AVE APT 4
COHOES NY
12047-3400
US

IV. Provider business mailing address

83 PARK AVE APT 4
COHOES NY
12047-3400
US

V. Phone/Fax

Practice location:
  • Phone: 518-286-0548
  • Fax:
Mailing address:
  • Phone: 518-286-0548
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code164W00000X
TaxonomyLicensed Practical Nurse
License Number309173
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: