=====================================================
General NPI Number Information
=====================================================
NPI Number | 1639737745
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | AUDREY KASE
-----------------------------------------------------
Gender | Female
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 06/04/2019
-----------------------------------------------------
Last Update Date | 06/04/2019
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 17 HAYS AVE
-----------------------------------------------------
City | KIRKWOOD
-----------------------------------------------------
State | NY
-----------------------------------------------------
Zip | 13795-1418
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 607-761-7111
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 91 MOUNTAIN VISTA LN
-----------------------------------------------------
City | GREAT BEND
-----------------------------------------------------
State | PA
-----------------------------------------------------
Zip | 18821-9547
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone |
-----------------------------------------------------
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 | PN283731
-----------------------------------------------------
License Number State | PA
-----------------------------------------------------