MEDICARE: MISS MAXINE ANGELA KING RN

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	163WH0200X	Home Health Registered Nurse	6276041	NY

General Provider Information

NPI Number	:	1902114770
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MISS MAXINE ANGELA KING RN

Provider Business Mailing Address
First Line	:	60 DAYTON ST
Second Line	:
City	:	ROCHESTER
State	:	NY
Zip	:	14621-3626
Country	:	US
Telephone Number	:	585-262-3615
Fax Number	:

Provider Business Practice Location Address
First Line	:	60 DAYTON ST
Second Line	:
City	:	ROCHESTER
State	:	NY
Zip	:	14621-3626
Country	:	US
Telephone Number	:	585-262-3615
Fax Number	:

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

Provider Enumeration Date	:	09/15/2010
Last Update Date	:	09/15/2010

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