MEDICARE: PATRICIA HEALY LPN

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	164W00000X	Licensed Practical Nurse	00214701	NY

General Provider Information

NPI Number	:	1134441504
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	PATRICIA HEALY LPN

Provider Business Mailing Address
First Line	:	1172 HAEBERLE AVE
Second Line	:
City	:	NIAGARA FALLS
State	:	NY
Zip	:	14301-1916
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	2827 MACKLEM AVE
Second Line	:
City	:	NIAGARA FALLS
State	:	NY
Zip	:	14305-1827
Country	:	US
Telephone Number	:	716-565-3626
Fax Number	:

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

Provider Enumeration Date	:	02/25/2010
Last Update Date	:	02/25/2010

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