Provider Demographics
NPI:1508149303
Name:MASTROIANNI, KIM VICTORIA (RN)
Entity Type:Individual
Prefix:MRS
First Name:KIM
Middle Name:VICTORIA
Last Name:MASTROIANNI
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 1:40 ALBION ST
Mailing Address - Street 2:
Mailing Address - City:SCOTIA
Mailing Address - State:NY
Mailing Address - Zip Code:12302-1229
Mailing Address - Country:US
Mailing Address - Phone:518-386-5119
Mailing Address - Fax:518-386-2808
Practice Address - Street 1:40 ALBION ST
Practice Address - Street 2:
Practice Address - City:SCOTIA
Practice Address - State:NY
Practice Address - Zip Code:12302-1229
Practice Address - Country:US
Practice Address - Phone:518-386-5119
Practice Address - Fax:518-386-2808
Is Sole Proprietor?:No
Enumeration Date:2011-09-28
Last Update Date:2011-09-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY304605163W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163W00000XNursing Service ProvidersRegistered Nurse