MEDICARE: MARGARET SUSAN HACKER RN

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	462487-1	NY
2	163WA2000X	Administrator Registered Nurse	467487-1	NY
3	163WH0200X	Home Health Registered Nurse	462487-1	NY

General Provider Information

NPI Number	:	1144552753
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MARGARET SUSAN HACKER RN

Provider Business Mailing Address
First Line	:	18 DAVID DR
Second Line	:
City	:	JOHNSON CITY
State	:	NY
Zip	:	13790-5117
Country	:	US
Telephone Number	:	607-351-0438
Fax Number	:

Provider Business Practice Location Address
First Line	:	18 DAVID DR
Second Line	:
City	:	JOHNSON CITY
State	:	NY
Zip	:	13790-5117
Country	:	US
Telephone Number	:	607-351-0438
Fax Number	:

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

Provider Enumeration Date	:	02/06/2010
Last Update Date	:	02/06/2010

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