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NPI Code Detail

MEDICARE: STACEY ADAMY LPN

MEDICARE: STACEY ADAMY 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
1164W00000XLicensed Practical Nurse299962NY

General Provider Information

NPI Number : 1144775024
Entity Type Code : Individual
Provider Name (Legal Business Name) : STACEY ADAMY LPN
Provider Business Mailing Address
First Line : 264 WAYLAND RD
Second Line :
City : SYRACUSE
State : NY
Zip : 13208-3316
Country : US
Telephone Number : 315-706-6693
Fax Number :
Provider Business Practice Location Address
First Line : 264 WAYLAND RD
Second Line :
City : SYRACUSE
State : NY
Zip : 13208-3316
Country : US
Telephone Number : 315-706-6693
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 08/19/2016
Last Update Date : 08/19/2016

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