Provider Demographics
NPI:1235385899
Name:NEUSCHWANDER, VIRGINIA K
Entity Type:Individual
Prefix:
First Name:VIRGINIA
Middle Name:K
Last Name:NEUSCHWANDER
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:VIRGINIA
Other - Middle Name:K
Other - Last Name:NEUSCHWANDER
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:
Mailing Address - Street 1:194 DECAMP RD
Mailing Address - Street 2:
Mailing Address - City:LOCKE
Mailing Address - State:NY
Mailing Address - Zip Code:13092-3256
Mailing Address - Country:US
Mailing Address - Phone:607-533-4218
Mailing Address - Fax:
Practice Address - Street 1:194 DECAMP RD
Practice Address - Street 2:
Practice Address - City:LOCKE
Practice Address - State:NY
Practice Address - Zip Code:13092-3256
Practice Address - Country:US
Practice Address - Phone:607-533-4218
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2008-08-14
Last Update Date:2008-08-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY285106-1164W00000X, 372600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes164W00000XNursing Service ProvidersLicensed Practical Nurse
No372600000XNursing Service Related ProvidersAdult Companion