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NPI Code Detail

MEDICARE: MS. VIJAYA RAMI VUTLA LPN

MEDICARE: MS. VIJAYA RAMI VUTLA 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
1164W00000XLicensed Practical Nurse2404731NY

General Provider Information

NPI Number : 1821232208
Entity Type Code : Individual
Provider Name (Legal Business Name) : MS. VIJAYA RAMI VUTLA LPN
Provider Business Mailing Address
First Line : 1050 W GENESEE ST
Second Line :
City : SYRACUSE
State : NY
Zip : 13204-2215
Country : US
Telephone Number : 315-424-3744
Fax Number : 315-424-3745
Provider Business Practice Location Address
First Line : 1050 W GENESEE ST
Second Line :
City : SYRACUSE
State : NY
Zip : 13204-2215
Country : US
Telephone Number : 315-424-3744
Fax Number : 315-424-3745
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 04/29/2009
Last Update Date : 09/02/2011

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