MEDICARE: LENORA A CHARNOVESKY 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	684496	NY

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	684496	OTHER	NY	REGISTERED NURSE

General Provider Information

NPI Number	:	1154735777
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	LENORA A CHARNOVESKY RN

Provider Business Mailing Address
First Line	:	519 HYLAN BLVD
Second Line	:
City	:	STATEN ISLAND
State	:	NY
Zip	:	10305-2067
Country	:	US
Telephone Number	:	732-546-1957
Fax Number	:

Provider Business Practice Location Address
First Line	:	519 HYLAN BLVD
Second Line	:
City	:	STATEN ISLAND
State	:	NY
Zip	:	10305-2067
Country	:	US
Telephone Number	:	732-546-1957
Fax Number	:

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

Provider Enumeration Date	:	06/12/2014
Last Update Date	:	06/12/2014

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