MEDICARE: BRENDA PRINS

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	163W00000X	Registered Nurse	456239-1	NY

General Provider Information

NPI Number	:	1639450067
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	BRENDA PRINS

Provider Business Mailing Address
First Line	:	1548 MOUNT ZOAR RD
Second Line	:
City	:	PINE CITY
State	:	NY
Zip	:	14871-9545
Country	:	US
Telephone Number	:	607-259-2709
Fax Number	:

Provider Business Practice Location Address
First Line	:	1548 MOUNT ZOAR RD
Second Line	:
City	:	PINE CITY
State	:	NY
Zip	:	14871-9545
Country	:	US
Telephone Number	:	607-259-2709
Fax Number	:

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

Provider Enumeration Date	:	08/30/2011
Last Update Date	:	08/30/2011

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Directions to “ BRENDA PRINS ” Practice Location

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