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NPI Code Detail

MEDICARE: PRISCELA LIZETTE KUGBLENU PA-C

MEDICARE: PRISCELA LIZETTE KUGBLENU PA-C
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
1363A00000XPhysician Assistant025029NY

General Provider Information

NPI Number : 1669032116
Entity Type Code : Individual
Provider Name (Legal Business Name) : PRISCELA LIZETTE KUGBLENU PA-C
Provider Business Mailing Address
First Line : 106 N PINE AVE APT 2
Second Line :
City : ALBANY
State : NY
Zip : 12203-1737
Country : US
Telephone Number : 518-512-6321
Fax Number :
Provider Business Practice Location Address
First Line : 407 ALBANY SHAKER RD
Second Line :
City : LOUDONVILLE
State : NY
Zip : 12211-1900
Country : US
Telephone Number : 518-435-1300
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 06/17/2019
Last Update Date : 06/01/2023

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Directions to “ PRISCELA LIZETTE KUGBLENU PA-C” Practice Location

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