Basic Information
Provider Information | |||||||||
NPI: | 1346475613 | ||||||||
EntityType: | 1 | ||||||||
ReplacementNPI: |   | ||||||||
OrganizationName: |   | ||||||||
LastName: | SPEICHER | ||||||||
FirstName: | JOANNE | ||||||||
MiddleName: | E | ||||||||
NamePrefix: |   | ||||||||
NameSuffix: |   | ||||||||
Credential: | NP | ||||||||
OtherOrganizationName: |   | ||||||||
OtherOrganizationType: |   | ||||||||
OtherLastName: |   | ||||||||
OtherFirstName: |   | ||||||||
OtherMiddleName: |   | ||||||||
OtherNamePrefix: |   | ||||||||
OtherNameSuffix: |   | ||||||||
OtherCredential: |   | ||||||||
OtherLastNameType: |   | ||||||||
Mailing Information | |||||||||
Address1: | 2359 SESSIONS HILL RD | ||||||||
Address2: |   | ||||||||
City: | HOMER | ||||||||
State: | NY | ||||||||
PostalCode: | 130779462 | ||||||||
CountryCode: | US | ||||||||
TelephoneNumber: | 6077539946 | ||||||||
FaxNumber: |   | ||||||||
Practice Location | |||||||||
Address1: | 22-24 EAST MAIN STREET | ||||||||
Address2: |   | ||||||||
City: | MARATHON | ||||||||
State: | NY | ||||||||
PostalCode: | 138030448 | ||||||||
CountryCode: | US | ||||||||
TelephoneNumber: | 6078493271 | ||||||||
FaxNumber: | 6078496357 | ||||||||
Other Information | |||||||||
ProviderEnumerationDate: | 05/15/2009 | ||||||||
LastUpdateDate: | 02/10/2016 | ||||||||
NPIDeactivationReasonCode: |   | ||||||||
NPIDeactivationDate: |   | ||||||||
NPIReactivationDate: |   | ||||||||
ProviderGenderCode: | F | ||||||||
AuthorizedOfficialLastName: |   | ||||||||
AuthorizedOfficialFirstName: |   | ||||||||
AuthorizedOfficialMiddleName: |   | ||||||||
AuthorizedOfficialTitleorPosition: |   | ||||||||
AuthorizedOfficialTelephone: |   | ||||||||
IsSoleProprietor: | N | ||||||||
IsOrganizationSubpart: |   | ||||||||
ParentOrganizationLBN: |   | ||||||||
AuthorizedOfficialNamePrefix: |   | ||||||||
AuthorizedOfficialNameSuffix: |   | ||||||||
AuthorizedOfficialCredential: |   | ||||||||
NPICertificationDate: |   |
Taxonomy Information
Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 163W00000X | 607074 | NY | N |   | Nursing Service Providers | Registered Nurse |   | 363LF0000X | 338793 | NY | Y |   | Physician Assistants & Advanced Practice Nursing Providers | Nurse Practitioner | Family |
No ID Information.