Healthcare Provider Details

I. General information

NPI: 1316221443
Provider Name (Legal Business Name): HOLLY M VACCA RN
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/07/2011
Last Update Date: 10/07/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1121 FOREST RD
SCHENECTADY NY
12303-1219
US

IV. Provider business mailing address

2476 NOTT ST E
SCHENECTADY NY
12309-4383
US

V. Phone/Fax

Practice location:
  • Phone: 518-881-3902
  • Fax:
Mailing address:
  • Phone: 518-374-8225
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code163W00000X
TaxonomyRegistered Nurse
License Number465829
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: