=====================================================
General NPI Number Information
=====================================================
NPI Number | 1295049005
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | DEBBIE CHRISPELL LPN
-----------------------------------------------------
Gender | Female
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 08/04/2010
-----------------------------------------------------
Last Update Date | 08/04/2010
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 38 FRONT ST
-----------------------------------------------------
City | BINGHAMTON
-----------------------------------------------------
State | NY
-----------------------------------------------------
Zip | 13905-4712
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 607-722-6461
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | RR 2 BOX 416
-----------------------------------------------------
City | ROME
-----------------------------------------------------
State | PA
-----------------------------------------------------
Zip | 18837-9560
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 570-395-3783
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position |
-----------------------------------------------------
Name |
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone |
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 164W00000X
-----------------------------------------------------
Taxonomy Name | Licensed Practical Nurse
-----------------------------------------------------
License Number | 301210-1
-----------------------------------------------------
License Number State | NY
-----------------------------------------------------