MEDICARE: JAMIE D BOVAIR ANP

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	363LA2200X	Adult Health Nurse Practitioner	308342	NY

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1811415789
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	JAMIE D BOVAIR ANP

Provider Business Mailing Address
First Line	:	100 PARK ST
Second Line	:
City	:	GLENS FALLS
State	:	NY
Zip	:	12801-4413
Country	:	US
Telephone Number	:	518-926-5924
Fax Number	:	518-926-6983

Provider Business Practice Location Address
First Line	:	327 BROADWAY
Second Line	:
City	:	FORT EDWARD
State	:	NY
Zip	:	12828-1233
Country	:	US
Telephone Number	:	518-747-1041
Fax Number	:	518-747-1022

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

Provider Enumeration Date	:	08/31/2017
Last Update Date	:	10/24/2024

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