Healthcare Provider Details

I. General information

NPI: 1114376944
Provider Name (Legal Business Name): ERIN LAMONTAGNE MACBETH FNP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/13/2016
Last Update Date: 02/23/2017
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1551 RANDOLPH RD
SCHENECTADY NY
12308-2015
US

IV. Provider business mailing address

1551 RANDOLPH RD
SCHENECTADY NY
12308-2015
US

V. Phone/Fax

Practice location:
  • Phone: 518-281-6029
  • Fax:
Mailing address:
  • Phone: 518-281-6029
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code163W00000X
TaxonomyRegistered Nurse
License Number701657-1
License Number StateNY
# 2
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily
License Number33341554
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: