MEDICARE: MRS. MILDRED MARIE DACE R.N

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	464592	NY
2	163WS0200X	School Registered Nurse	464592	NY

General Provider Information

NPI Number	:	1316205438
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MRS. MILDRED MARIE DACE R.N

Provider Business Mailing Address
First Line	:	1840 BOGART AVE
Second Line	:
City	:	BRONX
State	:	NY
Zip	:	10462-3755
Country	:	US
Telephone Number	:	718-822-0689
Fax Number	:	718-319-0862

Provider Business Practice Location Address
First Line	:	1840 BOGART AVE
Second Line	:
City	:	BRONX
State	:	NY
Zip	:	10462-3755
Country	:	US
Telephone Number	:	718-822-0689
Fax Number	:	718-319-0862

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

Provider Enumeration Date	:	04/26/2012
Last Update Date	:	04/26/2012

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