MEDICARE: REGISTERED NURSE

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	242977	NY

General Provider Information

NPI Number	:	1801224936
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	REGISTERED NURSE

Provider Business Mailing Address
First Line	:	875 MORRISON AVE APT 4D
Second Line	:
City	:	BRONX
State	:	NY
Zip	:	10473-4415
Country	:	US
Telephone Number	:	718-617-9077
Fax Number	:

Provider Business Practice Location Address
First Line	:	875 MORRISON AVE APT 4D
Second Line	:
City	:	BRONX
State	:	NY
Zip	:	10473-4415
Country	:	US
Telephone Number	:	718-617-9077
Fax Number	:

Authorized Official
Title or Position	:	REGISTERED NURSE
Name	:	MARTHA ANN KENNEDY
Credential	:
Telephone Number	:	718-617-9077

Provider Enumeration Date	:	10/29/2013
Last Update Date	:	10/29/2013

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