Healthcare Provider Details

I. General information

NPI: 1982754073
Provider Name (Legal Business Name): KIMBERLEE JOY ALICANDRI R.N.
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 01/11/2007
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

29 FRANKO DR
KERHONKSON NY
12446-3310
US

IV. Provider business mailing address

29 FRANKO DR
KERHONKSON NY
12446-3310
US

V. Phone/Fax

Practice location:
  • Phone: 845-626-0042
  • Fax:
Mailing address:
  • Phone: 845-626-0042
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code163WH0200X
TaxonomyHome Health Registered Nurse
License Number458189-1
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: