MEDICARE: DEBRA KAY PRESTON FNP

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	363LF0000X	Family Nurse Practitioner	F336802-1	NY

General Provider Information

NPI Number	:	1336428952
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DEBRA KAY PRESTON FNP

Provider Business Mailing Address
First Line	:	784 PRE EMPTION RD
Second Line	:
City	:	GENEVA
State	:	NY
Zip	:	14456-2018
Country	:	US
Telephone Number	:	315-789-2153
Fax Number	:	315-789-4781

Provider Business Practice Location Address
First Line	:	784 PRE EMPTION RD
Second Line	:
City	:	GENEVA
State	:	NY
Zip	:	14456-2018
Country	:	US
Telephone Number	:	315-789-2153
Fax Number	:	315-789-4781

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

Provider Enumeration Date	:	08/12/2011
Last Update Date	:	08/12/2011

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