MEDICARE: SANDRA KINZER

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	681420	NY

General Provider Information

NPI Number	:	1760800494
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	SANDRA KINZER

Provider Business Mailing Address
First Line	:	21 CAMMERER AVE
Second Line	:
City	:	EAST ROCKAWAY
State	:	NY
Zip	:	11518-1905
Country	:	US
Telephone Number	:	516-596-7669
Fax Number	:

Provider Business Practice Location Address
First Line	:	21 CAMMERER AVE
Second Line	:
City	:	EAST ROCKAWAY
State	:	NY
Zip	:	11518-1905
Country	:	US
Telephone Number	:	516-596-7669
Fax Number	:

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

Provider Enumeration Date	:	03/31/2014
Last Update Date	:	03/31/2014

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