Healthcare Provider Details

I. General information

NPI: 1588527808
Provider Name (Legal Business Name): NATALIE BAMERICK RN
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 12/04/2025
Last Update Date: 12/04/2025
Certification Date: 12/04/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5396 SPRINGVIEW DR
FAYETTEVILLE NY
13066-9678
US

IV. Provider business mailing address

5396 SPRINGVIEW DR
FAYETTEVILLE NY
13066-9678
US

V. Phone/Fax

Practice location:
  • Phone: 315-403-2499
  • Fax: 315-403-2499
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code163W00000X
TaxonomyRegistered Nurse
License Number652681
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: