Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 176B00000X | Midwife | F001157 | NY |
NPI | 1104946011 |
---|---|
Provider Name | Kelly Therese Mcdermott |
First Address | Albany, NY 12208-1915 |
Second Address | Albany, NY 12203-1746 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 02/04/2007 |
Last Update Date | 30/11/2015 |