Healthcare Provider Details

I. General information

NPI: 1285510057
Provider Name (Legal Business Name): AMBER M LARUE RN
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/15/2025
Last Update Date: 08/15/2025
Certification Date: 08/15/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

125 FINNEY BLVD
MALONE NY
12953-1067
US

IV. Provider business mailing address

324 COUNTY ROUTE 51 BLDG 1
MALONE NY
12953-4502
US

V. Phone/Fax

Practice location:
  • Phone: 518-483-3261
  • Fax: 518-483-3383
Mailing address:
  • Phone: 518-651-2302
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code163W00000X
TaxonomyRegistered Nurse
License Number595249
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: