Provider Demographics
NPI:1760682587
Name:TOWNER, VICKI LEIGH
Entity Type:Individual
Prefix:MR
First Name:VICKI
Middle Name:LEIGH
Last Name:TOWNER
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6006 ROUTE 226
Mailing Address - Street 2:
Mailing Address - City:SAVONA
Mailing Address - State:NY
Mailing Address - Zip Code:14879-9715
Mailing Address - Country:US
Mailing Address - Phone:607-583-2628
Mailing Address - Fax:
Practice Address - Street 1:6006 ROUTE 226
Practice Address - Street 2:
Practice Address - City:SAVONA
Practice Address - State:NY
Practice Address - Zip Code:14879-9715
Practice Address - Country:US
Practice Address - Phone:607-583-2628
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-07-19
Last Update Date:2007-07-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY1448831164W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes164W00000XNursing Service ProvidersLicensed Practical Nurse
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY01870213Medicaid