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NPI Code Detail

MEDICARE: MRS. JOETTA AHLEEN POLLOCK RN

MEDICARE: MRS. JOETTA AHLEEN POLLOCK 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
1163WS0200XSchool Registered Nurse425546-1NY

General Provider Information

NPI Number : 1164799052
Entity Type Code : Individual
Provider Name (Legal Business Name) : MRS. JOETTA AHLEEN POLLOCK RN
Provider Business Mailing Address
First Line : 7755 ROUTE 83
Second Line :
City : SOUTH DAYTON
State : NY
Zip : 14138-9633
Country : US
Telephone Number : 716-988-3291
Fax Number :
Provider Business Practice Location Address
First Line : 7755 ROUTE 83
Second Line :
City : SOUTH DAYTON
State : NY
Zip : 14138-9633
Country : US
Telephone Number : 716-988-3291
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 11/21/2011
Last Update Date : 11/21/2011

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