| NPI | 1508514340 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | DEBBRA PEDERSEN Credentialing Specialist 518-631-8268 |
| Organization Subpart ? | No |
| Primary Taxonomy | 363LP0808X Nurse Practitioner, Psych/Mental Health |
| Enumeration Date | 2022-03-11 |
| Last Update Date | 2022-03-11 |