Healthcare Provider Details

I. General information

NPI: 1528199791
Provider Name (Legal Business Name): PEGGY T CAIN RN
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/08/2007
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

150 VAN BUREN ST
NEWARK NY
14513-1238
US

IV. Provider business mailing address

2041 SHERBURNE RD
WALWORTH NY
14568-9331
US

V. Phone/Fax

Practice location:
  • Phone: 315-331-7741
  • Fax: 315-331-0566
Mailing address:
  • Phone: 315-986-1321
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code163W00000X
TaxonomyRegistered Nurse
License Number2189351
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: