Healthcare Provider Details

I. General information

NPI: 1114933165
Provider Name (Legal Business Name): PATRICIA IRENE MUTTERER NPP (NURSE PRACTI
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/31/2006
Last Update Date: 08/20/2021
Certification Date: 08/20/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

260 SOUTH PEARL STREET
ALBANY NY
12202-1809
US

IV. Provider business mailing address

4 ATRIUM DRIVE SUITE 100
ALBANY NY
12205-1441
US

V. Phone/Fax

Practice location:
  • Phone: 518-447-4555
  • Fax: 518-447-4661
Mailing address:
  • Phone: 518-374-0295
  • Fax: 518-377-3729

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code163WP0808X
TaxonomyPsychiatric/Mental Health Registered Nurse
License Number288683-1
License Number StateNY
# 2
Primary TaxonomyY
Taxonomy Code363LP0808X
TaxonomyPsychiatric/Mental Health Nurse Practitioner
License NumberF400332-01
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: