MEDICARE: ANDREA PAULETTE MARKLEY LPN

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	164W00000X	Licensed Practical Nurse	303733	NY

General Provider Information

NPI Number	:	1396004214
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	ANDREA PAULETTE MARKLEY LPN

Provider Business Mailing Address
First Line	:	143 LAFAYETTE CIR
Second Line	:
City	:	COBLESKILL
State	:	NY
Zip	:	12043-6101
Country	:	US
Telephone Number	:	518-694-9907
Fax Number	:

Provider Business Practice Location Address
First Line	:	150 BROADWAY STE 310
Second Line	:
City	:	MENANDS
State	:	NY
Zip	:	12204-2726
Country	:	US
Telephone Number	:	518-694-9907
Fax Number	:

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

Provider Enumeration Date	:	05/12/2012
Last Update Date	:	05/12/2012

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