Basic Information
| Provider Information | |||||||||
| NPI: | 1427373190 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | RUSHBY | ||||||||
| FirstName: | VICKI | ||||||||
| MiddleName: | LYNN | ||||||||
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| Credential: | L.P.N | ||||||||
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| Mailing Information | |||||||||
| Address1: | PO BOX 45 | ||||||||
| Address2: | RAYMOND WRIGHT AVE. | ||||||||
| City: | WITHERBEE | ||||||||
| State: | NY | ||||||||
| PostalCode: | 129980045 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5189427088 | ||||||||
| FaxNumber: | |||||||||
| Practice Location | |||||||||
| Address1: | 3384 FISHER HILL ROAD | ||||||||
| Address2: | APARTMENT 1 | ||||||||
| City: | MINEVILLE | ||||||||
| State: | NY | ||||||||
| PostalCode: | 12956 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5185463218 | ||||||||
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| Other Information | |||||||||
| ProviderEnumerationDate: | 04/06/2010 | ||||||||
| LastUpdateDate: | 04/06/2010 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | Y | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 164W00000X | 10 261852 | NY | Y | Nursing Service Providers | Licensed Practical Nurse |
No ID Information.