Healthcare Provider Details

I. General information

NPI: 1669808556
Provider Name (Legal Business Name): LINDA MARIE KUDREWICZ RN
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/24/2013
Last Update Date: 09/24/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

28 GROVE ST
MOHAWK NY
13407-1200
US

IV. Provider business mailing address

28 GROVE ST
MOHAWK NY
13407-1200
US

V. Phone/Fax

Practice location:
  • Phone: 315-866-2620
  • Fax: 315-867-2909
Mailing address:
  • Phone: 315-866-2620
  • Fax: 315-867-2909

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code163WS0200X
TaxonomySchool Registered Nurse
License Number396758-1
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: