=====================================================
General NPI Number Information
=====================================================
NPI Number | 1629489851
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | VIRGINIA KING RN
-----------------------------------------------------
Gender | Female
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 05/09/2014
-----------------------------------------------------
Last Update Date | 05/09/2014
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 12 N STATE ST
-----------------------------------------------------
City | RIPLEY
-----------------------------------------------------
State | NY
-----------------------------------------------------
Zip | 14775-9762
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 716-736-2631
-----------------------------------------------------
Fax | 716-736-6206
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 12 N STATE ST
-----------------------------------------------------
City | RIPLEY
-----------------------------------------------------
State | NY
-----------------------------------------------------
Zip | 14775-9762
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 716-736-2631
-----------------------------------------------------
Fax | 716-736-6206
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position |
-----------------------------------------------------
Name |
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone |
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 163WS0200X
-----------------------------------------------------
Taxonomy Name | School Registered Nurse
-----------------------------------------------------
License Number | 6476-11-1
-----------------------------------------------------
License Number State | NY
-----------------------------------------------------