Healthcare Provider Details

I. General information

NPI: 1063509909
Provider Name (Legal Business Name): COUNTY OF WAYNE
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/10/2006
Last Update Date: 06/07/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1519 NYE RD. SUITE 200
LYONS NY
14489
US

IV. Provider business mailing address

1519 NYE RD. SUITE 200
LYONS NY
14489
US

V. Phone/Fax

Practice location:
  • Phone: 315-946-5749
  • Fax: 315-946-5762
Mailing address:
  • Phone: 315-946-5749
  • Fax: 315-946-5762

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code252Y00000X
TaxonomyEarly Intervention Provider Agency
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code251300000X
TaxonomyLocal Education Agency (LEA)
License Number
License Number State

VIII. Authorized Official

Name: MRS. DIANE M DEVLIN
Title or Position: DIRECTOR OF PUBLIC HEALTH
Credential: MS, RN, ANP
Phone: 315-946-5749