Healthcare Provider Details

I. General information

NPI: 1588630164
Provider Name (Legal Business Name): JUDITH A. N. MAKOWIEC FNP
Entity Type: Individual
Gender: Female
Sole Proprietor: X

Provider Other Name: JUDITH A. NEILSON NP

II. Dates (important events)

Enumeration Date: 02/24/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

25 OAK TREE LN
TROY NY
12180-6980
US

IV. Provider business mailing address

1270 BELMONT AVE
SCHENECTADY NY
12308-2104
US

V. Phone/Fax

Practice location:
  • Phone: 518-279-3501
  • Fax:
Mailing address:
  • Phone: 518-386-3539
  • Fax: 518-382-4570

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number330242
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: