Healthcare Provider Details

I. General information

NPI: 1497789184
Provider Name (Legal Business Name): JANET E. HOULIHAN NP/PA
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/10/2006
Last Update Date: 07/14/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1101 NOTT ST
SCHENECTADY NY
12308-2425
US

IV. Provider business mailing address

1462 ERIE BLVD SUITE 2
SCHENECTADY NY
12305-1026
US

V. Phone/Fax

Practice location:
  • Phone: 518-243-4000
  • Fax:
Mailing address:
  • Phone: 518-243-1500
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code163WG0000X
TaxonomyGeneral Practice Registered Nurse
License Number231831
License Number StateNY
# 2
Primary TaxonomyN
Taxonomy Code363AM0700X
TaxonomyMedical Physician Assistant
License Number002769
License Number StateNY
# 3
Primary TaxonomyY
Taxonomy Code363LA2200X
TaxonomyAdult Health Nurse Practitioner
License Number300443
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: