MEDICARE: PAULETTE MAUREEN GARBUTT 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	238203	NY

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	238203	OTHER	NY	LPN LICENSE

General Provider Information

NPI Number	:	1619290723
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	PAULETTE MAUREEN GARBUTT LPN

Provider Business Mailing Address
First Line	:	1001 JEROME AVE
Second Line	:	APT 10E
City	:	BRONX
State	:	NY
Zip	:	10452-5704
Country	:	US
Telephone Number	:	718-588-6491
Fax Number	:

Provider Business Practice Location Address
First Line	:	1001 JEROME AVE
Second Line	:	APT 10E
City	:	BRONX
State	:	NY
Zip	:	10452-5704
Country	:	US
Telephone Number	:	718-588-6491
Fax Number	:

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

Provider Enumeration Date	:	03/03/2010
Last Update Date	:	03/03/2010

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