MEDICARE: MISS ALICIA NICOLE ECTOR

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	305412-1	NY

General Provider Information

NPI Number	:	1992137749
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MISS ALICIA NICOLE ECTOR

Provider Business Mailing Address
First Line	:	284 E CHESTER ST
Second Line	:	APT.D2
City	:	KINGSTON
State	:	NY
Zip	:	12401-3100
Country	:	US
Telephone Number	:	845-399-9126
Fax Number	:

Provider Business Practice Location Address
First Line	:	284 E CHESTER ST
Second Line	:	APT.D2
City	:	KINGSTON
State	:	NY
Zip	:	12401-3100
Country	:	US
Telephone Number	:	845-399-9126
Fax Number	:

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

Provider Enumeration Date	:	08/04/2013
Last Update Date	:	08/04/2013

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Directions to “ MISS ALICIA NICOLE ECTOR ” Practice Location

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