Paulette Rena Roque
Individual provider Active NPI Licensed Practical Nurse · Canastota, NY
NPI 1750426508 · NPPES record last updated Jul 8, 2007
Key facts
- NPI
- 1750426508
- Entity type
- Individual (NPI type 1)
- Primary specialty
- Licensed Practical Nurse 164W00000X
- License
- 215367-1 (NY)
- Practice address
- 113 Caroline St
Canastota, NY 13032-1204 - Phone
- (315) 875-5024
- NPI assigned
- Feb 20, 2007
- 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
| License | State | Type | Specialty |
|---|---|---|---|
| 215367-1 | NY | MD | Licensed Practical Nurse |
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Licensed Practical Nurse | 164W00000X | 215367-1 | NY | Yes |
Addresses
Primary practice location
113 Caroline St
Canastota, NY 13032-1204
Mailing address
113 Caroline St
Canastota, NY 13032-1204
Other identifiers
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 01999182 | Medicaid | NY |
Other providers in Canastota, NY
- Elizabeth Marie Parker
- Nathan J Philo Sr.
- Physical Therapy & Electrophysiologic Specialist of Ny PLLC
- Donald Max Pirodsky
- Richard William Puente
- Alfred Michael Russitano
- Catherine Jane Saverino
- Alicia J Sgarlata
- Kathryn Jean Shaver
- Michael Siegenthaler
All providers in Canastota, NY · Licensed Practical Nurse in New York
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on Jul 8, 2007. Information in NPPES is self-reported and not verified by CMS.
- NUCC Health Care Provider Taxonomy: specialty names.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.