Healthcare Provider Details

I. General information

NPI: 1962771428
Provider Name (Legal Business Name): RAMONA MARIE UDOVICH R.N.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 12/29/2011
Last Update Date: 12/29/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

93 MAIN ST
RICHFIELD SPRINGS NY
13439-4504
US

IV. Provider business mailing address

93 MAIN STREET P.O. BOX 631
RICHFIELD SPRINGS NY
13439-0631
US

V. Phone/Fax

Practice location:
  • Phone: 315-858-0610
  • Fax: 315-858-2440
Mailing address:
  • Phone: 315-858-0610
  • Fax: 315-858-2440

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code163W00000X
TaxonomyRegistered Nurse
License Number255598-1
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: