Healthcare Provider Details

I. General information

NPI: 1912276429
Provider Name (Legal Business Name): PAULA JUDITH LINDBERG R.N.
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 12/29/2011
Last Update Date: 12/29/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

7303 STATE ROUTE 20
MADISON NY
13402-9774
US

IV. Provider business mailing address

7303 STATE ROUTE 20
MADISON NY
13402-9774
US

V. Phone/Fax

Practice location:
  • Phone: 315-893-1878
  • Fax: 315-893-7111
Mailing address:
  • Phone: 315-893-1878
  • Fax: 315-893-7111

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code163WS0200X
TaxonomySchool Registered Nurse
License Number263375
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: