Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 176B00000X | Midwife | 001701 | NY |
NPI | 1083001853 |
---|---|
Provider Name | Carly Koelsch |
First Address | Glens Falls, NY 12801-4313 |
Second Address | Glens Falls, NY 12801-4313 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 20/04/2015 |
Last Update Date | 14/01/2021 |