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NPI Code Detail

MEDICARE: BERNADETTE DRAGOON RN, PHN

MEDICARE: BERNADETTE DRAGOON RN, PHN
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
1163W00000XRegistered Nurse505093CA
2171M00000XCase Manager/Care Coordinator547071NY

General Provider Information

NPI Number : 1134250285
Entity Type Code : Individual
Provider Name (Legal Business Name) : BERNADETTE DRAGOON RN, PHN
Provider Business Mailing Address
First Line : 355 W MAIN ST
Second Line :
City : MALONE
State : NY
Zip : 12953-1827
Country : US
Telephone Number : 518-481-1716
Fax Number : 518-483-9378
Provider Business Practice Location Address
First Line : 355 W MAIN ST
Second Line :
City : MALONE
State : NY
Zip : 12953-1827
Country : US
Telephone Number : 518-481-1716
Fax Number : 518-483-9378
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 03/08/2007
Last Update Date : 07/25/2012

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