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NPI Code Detail

MEDICARE: STEPHANIE NEWBERRY RN

MEDICARE: STEPHANIE NEWBERRY 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
1163W00000XRegistered Nurse477432NY

Other Identifiers

# Provider Identifier Provider Identifier Type Provider Identifier State Provider Identifier Issuer
1477432OTHERNYREGISTERED NURSING LICENSE

General Provider Information

NPI Number : 1255869889
Entity Type Code : Individual
Provider Name (Legal Business Name) : STEPHANIE NEWBERRY RN
Provider Business Mailing Address
First Line : 44 HOLLYWOOD CRES
Second Line :
City : ROCHESTER
State : NY
Zip : 14617-2116
Country : US
Telephone Number : 585-214-9945
Fax Number :
Provider Business Practice Location Address
First Line : 44 HOLLYWOOD CRES
Second Line :
City : ROCHESTER
State : NY
Zip : 14617-2116
Country : US
Telephone Number : 585-214-9945
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 05/26/2017
Last Update Date : 05/26/2017

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