Healthcare Provider Details

I. General information

NPI: 1447450671
Provider Name (Legal Business Name): AMBER ANTONUCCI R.N.
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 07/25/2007
Last Update Date: 07/25/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

476 1ST ST
NEWBURGH NY
12550-4203
US

IV. Provider business mailing address

476 1ST ST
NEWBURGH NY
12550-4203
US

V. Phone/Fax

Practice location:
  • Phone: 845-565-9475
  • Fax:
Mailing address:
  • Phone: 845-565-9475
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code163W00000X
TaxonomyRegistered Nurse
License Number22557670
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: