Healthcare Provider Details

I. General information

NPI: 1427334648
Provider Name (Legal Business Name): ERIN PATRICIA VANDEMARK RN
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 11/02/2011
Last Update Date: 03/01/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3 CHARLES ST
ELLENVILLE NY
12428-2303
US

IV. Provider business mailing address

31 EUGENE ST
NAPANOCH NY
12458-2806
US

V. Phone/Fax

Practice location:
  • Phone: 845-647-4502
  • Fax:
Mailing address:
  • Phone: 845-264-8481
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code163W00000X
TaxonomyRegistered Nurse
License Number648451-1
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: