Provider Demographics
NPI:1154599215
Name:BACHMANN, KEVIN W (LPN)
Entity type:Individual
Prefix:
First Name:KEVIN
Middle Name:W
Last Name:BACHMANN
Suffix:
Gender:M
Credentials:LPN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 143
Mailing Address - Street 2:43784 ROUTE 37
Mailing Address - City:REDWOOD
Mailing Address - State:NY
Mailing Address - Zip Code:13679-0143
Mailing Address - Country:US
Mailing Address - Phone:315-482-6931
Mailing Address - Fax:
Practice Address - Street 1:43784 NYS ROUTE 37
Practice Address - Street 2:
Practice Address - City:REDWOOD
Practice Address - State:NY
Practice Address - Zip Code:13679
Practice Address - Country:US
Practice Address - Phone:315-482-6931
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2008-02-12
Last Update Date:2008-02-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY253194-1164W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes164W00000XNursing Service ProvidersLicensed Practical Nurse