MEDICARE: SHARON CHRISTIE MURA-NAUMCHIK 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	291671-1	NY

General Provider Information

NPI Number	:	1760735419
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	SHARON CHRISTIE MURA-NAUMCHIK LPN

Provider Business Mailing Address
First Line	:	9 BARTLETT ST
Second Line	:
City	:	ELLENVILLE
State	:	NY
Zip	:	12428-1501
Country	:	US
Telephone Number	:	914-388-7625
Fax Number	:

Provider Business Practice Location Address
First Line	:	9 BARTLETT ST
Second Line	:
City	:	ELLENVILLE
State	:	NY
Zip	:	12428-1501
Country	:	US
Telephone Number	:	914-388-7625
Fax Number	:

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

Provider Enumeration Date	:	10/18/2012
Last Update Date	:	10/18/2012

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