Healthcare Provider Details

I. General information

NPI: 1174198360
Provider Name (Legal Business Name): MOHAWK VALLEY RN PLLC FRANK B. SOUZA
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/21/2021
Last Update Date: 05/21/2021
Certification Date: 05/20/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2209 GENESEE ST
UTICA NY
13501-5930
US

IV. Provider business mailing address

1755 HIGBY RD
FRANKFORT NY
13340-4322
US

V. Phone/Fax

Practice location:
  • Phone: 315-507-1344
  • Fax:
Mailing address:
  • Phone: 315-507-1344
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code163WR0006X
TaxonomyRegistered Nurse First Assistant
License Number
License Number State

VIII. Authorized Official

Name: MR. FRANK BRIAN SOUZA
Title or Position: OWNER
Credential: CRNFA
Phone: 315-507-1344