Healthcare Provider Details

I. General information

NPI: 1760749550
Provider Name (Legal Business Name): MARCIE LYNN LA PLANTE RN
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 04/18/2012
Last Update Date: 04/18/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2941 AMSTERDAM RD LOT 11
SCOTIA NY
12302-6340
US

IV. Provider business mailing address

2941 AMSTERDAM RD LOT 11
SCOTIA NY
12302-6340
US

V. Phone/Fax

Practice location:
  • Phone: 518-847-3267
  • Fax: 518-464-6393
Mailing address:
  • Phone: 518-847-3267
  • Fax: 518-464-6393

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code163W00000X
TaxonomyRegistered Nurse
License Number526877
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: