Healthcare Provider Details

I. General information

NPI: 1427350354
Provider Name (Legal Business Name): PETRA CAROLINE OCLAIR RN
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 11/29/2010
Last Update Date: 11/29/2010
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1405 FULTON AVE
SCHENECTADY NY
12308-1402
US

IV. Provider business mailing address

600 MCCLELLAN ST 2 WEST
SCHENECTADY NY
12304-1009
US

V. Phone/Fax

Practice location:
  • Phone: 518-243-1313
  • Fax: 518-831-7007
Mailing address:
  • Phone: 518-347-5400
  • Fax: 518-347-5222

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code163W00000X
TaxonomyRegistered Nurse
License Number464365
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: