Healthcare Provider Details

I. General information

NPI: 1609144708
Provider Name (Legal Business Name): ANNE MARIE SWOTA RN
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 12/05/2011
Last Update Date: 01/15/2020
Certification Date: 01/15/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

970 ROUTE 146 KODA MIDDLE SCHOOL
CLIFTON PARK NY
12065-3687
US

IV. Provider business mailing address

970 ROUTE 146 KODA MIDDLE SCHOOL
CLIFTON PARK NY
12065-3687
US

V. Phone/Fax

Practice location:
  • Phone: 518-881-0471
  • Fax: 518-881-0416
Mailing address:
  • Phone: 518-881-0471
  • Fax: 518-881-0416

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code163WS0200X
TaxonomySchool Registered Nurse
License Number344659-1
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: