Healthcare Provider Details

I. General information

NPI: 1295340404
Provider Name (Legal Business Name): AMY C MIGNOT SCHOOL RN
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/14/2020
Last Update Date: 09/14/2020
Certification Date: 09/14/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

15 BIG CROSS ST
GLENS FALLS NY
12801-4213
US

IV. Provider business mailing address

15 BIG CROSS ST
GLENS FALLS NY
12801-4213
US

V. Phone/Fax

Practice location:
  • Phone: 518-792-2619
  • Fax: 518-792-2668
Mailing address:
  • Phone: 518-792-2619
  • Fax: 518-792-2668

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code163WS0200X
TaxonomySchool Registered Nurse
License Number594818
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: