Healthcare Provider Details

I. General information

NPI: 1104827021
Provider Name (Legal Business Name): BARBARA A ELLIOTT CAPOGNA CRNA
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/02/2005
Last Update Date: 01/06/2017
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1201 NOTT ST SUITE 106
SCHENECTADY NY
12308-2589
US

IV. Provider business mailing address

1201 NOTT ST SUITE 106
SCHENECTADY NY
12308-2589
US

V. Phone/Fax

Practice location:
  • Phone: 518-374-3123
  • Fax: 518-374-9711
Mailing address:
  • Phone: 518-374-3123
  • Fax: 518-374-9711

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code367500000X
TaxonomyCertified Registered Nurse Anesthetist
License Number286842-1
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: