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General NPI Number Information
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NPI Number | 1740720895
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Entity Type | Organization
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Legal Business Name | BRIDGETT SPANO
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Dates
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Enumeration Date | 03/07/2017
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Last Update Date | 03/07/2017
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Provider Practice Location Address
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Address Line | 6381 TRENTON RD
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City | UTICA
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State | NY
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Zip | 13502-6817
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Country | US
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Telephone | 315-520-4601
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Fax |
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Provider Business Mailing Address
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Address Line | 6381 TRENTON RD
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City | UTICA
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State | NY
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Zip | 13502-6817
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Country | US
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Telephone | 315-520-4601
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Fax |
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Authorized Official
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Title or Position | LICENSED PRACTICAL NURSE
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Name | MISS BRIDGETT MARY SPANO
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Credential | LPN
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Telephone | 315-520-4601
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 251E00000X
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Taxonomy Name | Home Health Agency
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License Number | 274037-1
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License Number State | NY
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