Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 176B00000X | Midwife | F000052-1 | NY |
N | 363LW0102X | Nurse Practitioner - Women's Health | F4207721 | NY |
NPI | 1043275050 |
---|---|
Provider Name | Alice K Delventhal |
First Address | Plattsburgh, NY 12901-2779 |
Second Address | Plattsburgh, NY 12901-2779 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 20/04/2006 |
Last Update Date | 17/10/2014 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
02737933 | (05) | NY |
J400020433 | MEDICARE PTAN (01) | NY |