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General NPI Number Information
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NPI Number | 1376733006
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Entity Type | Individual
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Provider Name | TAMMY LOUISE FUSCO R.N.
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Gender | Female
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Dates
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Enumeration Date | 07/30/2007
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Last Update Date | 07/30/2007
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Provider Practice Location Address
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Address Line | 5240 BROOKHAVEN DR
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City | CLARENCE
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State | NY
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Zip | 14031-1612
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Country | US
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Telephone | 716-759-6707
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Fax |
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Provider Business Mailing Address
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Address Line | 691 MAPLE RD
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City | EAST AURORA
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State | NY
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Zip | 14052-1025
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Country | US
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Telephone | 716-655-6393
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 163WP0200X
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Taxonomy Name | Pediatric Registered Nurse
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License Number | 369-396-1
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License Number State | NY
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