MEDICARE: MISS GRACE A PFEIFER PMHNP

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	363LP0808X	Psychiatric/Mental Health Nurse Practitioner	403492	NY

General Provider Information

NPI Number	:	1184297558
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MISS GRACE A PFEIFER PMHNP

Provider Business Mailing Address
First Line	:	38 PINE RIDGE I
Second Line	:
City	:	HALFMOON
State	:	NY
Zip	:	12065-5636
Country	:	US
Telephone Number	:	518-892-7721
Fax Number	:

Provider Business Practice Location Address
First Line	:	427 GUY PARK AVE STE 1
Second Line	:
City	:	AMSTERDAM
State	:	NY
Zip	:	12010-1060
Country	:	US
Telephone Number	:	518-842-1900
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	07/22/2021
Last Update Date	:	07/22/2021

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