=====================================================
General NPI Number Information
=====================================================
NPI Number | 1073876363
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | MRS. APRIL MARIE HOUSE
-----------------------------------------------------
Gender | Female
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 06/21/2012
-----------------------------------------------------
Last Update Date | 06/21/2012
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 47 S LAKE AVE
-----------------------------------------------------
City | BERGEN
-----------------------------------------------------
State | NY
-----------------------------------------------------
Zip | 14416-9419
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 585-469-0326
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 47 S LAKE AVE
-----------------------------------------------------
City | BERGEN
-----------------------------------------------------
State | NY
-----------------------------------------------------
Zip | 14416-9419
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 585-469-0326
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position |
-----------------------------------------------------
Name |
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone |
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 171M00000X
-----------------------------------------------------
Taxonomy Name | Case Manager/Care Coordinator
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State |
-----------------------------------------------------
Taxonomy #2
-----------------------------------------------------
Taxonomy Code | 174400000X
-----------------------------------------------------
Taxonomy Name | Specialist
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State |
-----------------------------------------------------