MEDICARE: ALTHEA ATKINSON 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
1	163WH0200X	Home Health Registered Nurse	620131	NY
2	163WH0200X	Home Health Registered Nurse	RN9374168	FL
3	163WH0200X	Home Health Registered Nurse	RN680042	PA

General Provider Information

NPI Number	:	1528518081
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	ALTHEA ATKINSON RN

Provider Business Mailing Address
First Line	:	4 RIVER ST
Second Line	:
City	:	PORT JERVIS
State	:	NY
Zip	:	12771-2918
Country	:	US
Telephone Number	:	347-248-4786
Fax Number	:

Provider Business Practice Location Address
First Line	:	4 RIVER ST
Second Line	:
City	:	PORT JERVIS
State	:	NY
Zip	:	12771-2918
Country	:	US
Telephone Number	:	845-672-4144
Fax Number	:

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

Provider Enumeration Date	:	10/09/2016
Last Update Date	:	10/09/2016

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