Healthcare Provider Details

I. General information

NPI: 1053681445
Provider Name (Legal Business Name): BARBARA DAVIS-MECONI R.N.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 01/03/2012
Last Update Date: 01/03/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

15 BROAD STREET
PLATTSBURGH NY
12901-3490
US

IV. Provider business mailing address

15 BROAD STREET (SRAFFORD MIDDLE SCHOOL)
PLATTSBURGH NY
12901-3490
US

V. Phone/Fax

Practice location:
  • Phone: 518-563-3170
  • Fax: 518-563-8520
Mailing address:
  • Phone: 518-563-3170
  • Fax: 518-563-8520

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code163WA2000X
TaxonomyAdministrator Registered Nurse
License NumberRN#280443
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: