Provider Demographics
NPI:1417719881
Name:FENTON, EMMA (RN)
Entity Type:Individual
Prefix:MS
First Name:EMMA
Middle Name:
Last Name:FENTON
Suffix:
Gender:F
Credentials:RN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:739 OLD STATE RD
Mailing Address - Street 2:
Mailing Address - City:POLAND
Mailing Address - State:NY
Mailing Address - Zip Code:13431-2215
Mailing Address - Country:US
Mailing Address - Phone:314-404-0481
Mailing Address - Fax:
Practice Address - Street 1:115 SCHOOLHOUSE RD
Practice Address - Street 2:
Practice Address - City:UTICA
Practice Address - State:NY
Practice Address - Zip Code:13502-1135
Practice Address - Country:US
Practice Address - Phone:315-266-3414
Practice Address - Fax:315-266-3416
Is Sole Proprietor?:Yes
Enumeration Date:2024-01-30
Last Update Date:2024-01-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY837282163WS0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163WS0200XNursing Service ProvidersRegistered NurseSchool