MEDICARE: MR. MICHAEL THOMAS HOOD LPN 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	164W00000X	Licensed Practical Nurse	307922-1	NY

General Provider Information

NPI Number	:	1912345224
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MR. MICHAEL THOMAS HOOD LPN NURSE

Provider Business Mailing Address
First Line	:	351 VILLAGE BLVD N
Second Line	:
City	:	BALDWINSVILLE
State	:	NY
Zip	:	13027-3015
Country	:	US
Telephone Number	:	315-491-7717
Fax Number	:

Provider Business Practice Location Address
First Line	:	351 VILLAGE BLVD N
Second Line	:
City	:	BALDWINSVILLE
State	:	NY
Zip	:	13027-3015
Country	:	US
Telephone Number	:	315-491-7717
Fax Number	:

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

Provider Enumeration Date	:	06/08/2013
Last Update Date	:	06/08/2013

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