=====================================================
General NPI Number Information
=====================================================
NPI Number | 1043688484
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | HERKIMER BOCES
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 09/02/2015
-----------------------------------------------------
Last Update Date | 09/02/2015
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 77 E NORTH ST
-----------------------------------------------------
City | ILION
-----------------------------------------------------
State | NY
-----------------------------------------------------
Zip | 13357-1269
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 315-867-2013
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 77 E NORTH ST
-----------------------------------------------------
City | ILION
-----------------------------------------------------
State | NY
-----------------------------------------------------
Zip | 13357-1269
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 315-867-2013
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | SCHOOL NURSE
-----------------------------------------------------
Name | MRS. MELINDA D CULVER
-----------------------------------------------------
Credential | RN
-----------------------------------------------------
Telephone | 315-360-0201
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 251J00000X
-----------------------------------------------------
Taxonomy Name | Nursing Care Agency
-----------------------------------------------------
License Number | 702670
-----------------------------------------------------
License Number State | NY
-----------------------------------------------------