Healthcare Provider Details

I. General information

NPI: 1346524253
Provider Name (Legal Business Name): NANCY J MEDICIS R.N.
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 10/11/2011
Last Update Date: 10/11/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

204 SASLON PARK DR
LIVERPOOL NY
13088-6430
US

IV. Provider business mailing address

7738 BAINBRIDGE DR
LIVERPOOL NY
13090-2574
US

V. Phone/Fax

Practice location:
  • Phone: 315-453-1194
  • Fax: 315-453-0278
Mailing address:
  • Phone: 315-451-5045
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code163W00000X
TaxonomyRegistered Nurse
License Number341956-1
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: