MEDICARE: JOYCE WALLACE-CHIN

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	163WS0200X	School Registered Nurse	4316421	NY

General Provider Information

NPI Number	:	1396056677
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	JOYCE WALLACE-CHIN

Provider Business Mailing Address
First Line	:	75 WELLINGTON RD
Second Line	:
City	:	ELMONT
State	:	NY
Zip	:	11003-1416
Country	:	US
Telephone Number	:	516-328-9133
Fax Number	:

Provider Business Practice Location Address
First Line	:	75 WELLINGTON RD
Second Line	:
City	:	ELMONT
State	:	NY
Zip	:	11003-1416
Country	:	US
Telephone Number	:	516-328-9133
Fax Number	:

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

Provider Enumeration Date	:	07/01/2010
Last Update Date	:	07/01/2010

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