Healthcare Provider Details

I. General information

NPI: 1134151848
Provider Name (Legal Business Name): MARIANNE L STALTERI C.N.M./NP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/06/2006
Last Update Date: 09/19/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1656 CHAMPLIN AVE OB CARE CENTER
NEW HARTFORD NY
13413-1068
US

IV. Provider business mailing address

1656 CHAMPLIN AVE OB CARE CENTER
NEW HARTFORD NY
13413-1068
US

V. Phone/Fax

Practice location:
  • Phone: 315-624-6241
  • Fax: 315-624-6395
Mailing address:
  • Phone: 315-624-6241
  • Fax: 315-624-6395

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code367A00000X
TaxonomyAdvanced Practice Midwife
License Number000765
License Number StateNY
# 2
Primary TaxonomyN
Taxonomy Code363LX0001X
TaxonomyObstetrics & Gynecology Nurse Practitioner
License Number36 360394
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: