Healthcare Provider Details

I. General information

NPI: 1477528669
Provider Name (Legal Business Name): CONNIE J SIGNOR RN PNP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 02/21/2006
Last Update Date: 12/13/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

813 WARREN ST
HUDSON NY
12534-3007
US

IV. Provider business mailing address

PO BOX 2000
HUDSON NY
12534-2000
US

V. Phone/Fax

Practice location:
  • Phone: 518-828-4125
  • Fax: 518-828-4842
Mailing address:
  • Phone: 518-828-8363
  • Fax: 518-697-3388

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LP0200X
TaxonomyPediatric Nurse Practitioner
License NumberF380772
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: