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NPI Code Detail

MEDICARE: HOLLY M VACCA RN

MEDICARE: HOLLY M VACCA 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 Nurse465829NY

Other Identifiers

# Provider Identifier Provider Identifier Type Provider Identifier State Provider Identifier Issuer
1MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number : 1316221443
Entity Type Code : Individual
Provider Name (Legal Business Name) : HOLLY M VACCA RN
Provider Business Mailing Address
First Line : 2476 NOTT ST E
Second Line :
City : SCHENECTADY
State : NY
Zip : 12309-4383
Country : US
Telephone Number : 518-374-8225
Fax Number :
Provider Business Practice Location Address
First Line : 1121 FOREST RD
Second Line :
City : SCHENECTADY
State : NY
Zip : 12303-1219
Country : US
Telephone Number : 518-881-3902
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 10/07/2011
Last Update Date : 10/07/2011

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