Healthcare Provider Details

I. General information

NPI: 1396496048
Provider Name (Legal Business Name): EMMA JIUSTO
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 01/14/2022
Last Update Date: 01/14/2022
Certification Date: 01/14/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1 ACADEMY ST
PRATTSBURGH NY
14873-9200
US

IV. Provider business mailing address

34 CENTER ST APT 101
HORNELL NY
14843-1956
US

V. Phone/Fax

Practice location:
  • Phone: 607-522-3795
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code163WS0200X
TaxonomySchool Registered Nurse
License Number772706
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: