Mecca Fadelyah Baxter, L.P.N.

Individual provider Active NPI Licensed Practical Nurse · Greece, NY

NPI 1326550765 · NPPES record last updated Oct 25, 2017

Key facts

NPI
1326550765
Entity type
Individual (NPI type 1)
Primary specialty
Licensed Practical Nurse 164W00000X
License
190628-1 (NY)
Practice address
66 Webwood Cir
Greece, NY 14626-4036
Phone
(585) 623-9990
NPI assigned
Oct 25, 2017
Sex
Female
Sole proprietor
Yes

Medicare participation

Medicare fee-for-service enrollment
Not listed in the public Medicare enrollment file

National Provider Directory

Medicare enrollment (NPD)
No

State licenses

LicenseStateTypeSpecialty
190628-1NYMDLicensed Practical Nurse

Specialties & licenses

Specialty (taxonomy)CodeLicenseStatePrimary
Licensed Practical Nurse 164W00000X 190628-1 NY Yes

Addresses

Primary practice location

66 Webwood Cir
Greece, NY 14626-4036

Mailing address

66 Webwood Cir
Greece, NY 14626-4036
Phone (585) 623-9990

Other providers in Greece, NY

All providers in Greece, NY · Licensed Practical Nurse in New York

Sources for this page

Verify at the official NPI Registry.