Healthcare Provider Details

I. General information

NPI: 1457188484
Provider Name (Legal Business Name): PRISCILLA TANSON
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 09/16/2024
Last Update Date: 09/16/2024
Certification Date: 09/15/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

75 NEW SCOTLAND AVE
ALBANY NY
12208-3409
US

IV. Provider business mailing address

37 LAWRENCE AVE
LATHAM NY
12110-5413
US

V. Phone/Fax

Practice location:
  • Phone: 518-549-6500
  • Fax:
Mailing address:
  • Phone: 703-861-7417
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code163WG0000X
TaxonomyGeneral Practice Registered Nurse
License Number870859
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: