| NPI | 1881179646 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | COURTNEY KNOWLES Payer Credentialing Manager 518-525-5634 |
| Organization Subpart ? | Yes |
| Primary Taxonomy | 176B00000X Midwife |
| Additional Taxonomies | 207Q00000X Family Medicine |
| 207V00000X Obstetrics & Gynecology | |
| 208000000X Pediatrics | |
| 261QM1300X Clinic/Center Multi-Specialty | |
| 363A00000X Physician Assistant | |
| 363L00000X Nurse Practitioner | |
| Enumeration Date | 2018-09-27 |
| Last Update Date | 2021-10-07 |