MEDICARE: ELEANOR CHRISTINE KLEIN FNP

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	163W00000X	Registered Nurse	5277205	NY
2	363LF0000X	Family Nurse Practitioner	F330945-1	NY

General Provider Information

NPI Number	:	1043216906
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	ELEANOR CHRISTINE KLEIN FNP

Provider Business Mailing Address
First Line	:	85 SOUTH WEST STREET
Second Line	:
City	:	HOMER
State	:	NY
Zip	:	13077
Country	:	US
Telephone Number	:	607-753-3797
Fax Number	:	607-753-6677

Provider Business Practice Location Address
First Line	:	2805 CINCINNATUS RD
Second Line	:
City	:	CINCINNATUS
State	:	NY
Zip	:	13040-9669
Country	:	US
Telephone Number	:	607-863-4126
Fax Number	:	607-863-3455

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	06/24/2005
Last Update Date	:	12/18/2017

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