Healthcare Provider Details

I. General information

NPI: 1205056553
Provider Name (Legal Business Name): ALICIA LOTTIE KRIVIT BSN,FNP
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 04/27/2007
Last Update Date: 08/14/2017
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

9741 RTE 97
CALLICOON NY
12723
US

IV. Provider business mailing address

PO BOX 34
CALLICOON NY
12723-0256
US

V. Phone/Fax

Practice location:
  • Phone: 845-887-6112
  • Fax:
Mailing address:
  • Phone: 845-866-1741
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363L00000X
TaxonomyNurse Practitioner
License NumberF331538
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: