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General NPI Number Information
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NPI Number | 1114147311
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Entity Type | Organization
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Legal Business Name | NORTHERN NURSE PRACTITIONERS - FAMILY HEALTH PLLC
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Dates
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Enumeration Date | 04/27/2007
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Last Update Date | 09/30/2020
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Provider Practice Location Address
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Address Line | 19472 US ROUTE 11 STE N101
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City | WATERTOWN
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State | NY
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Zip | 13601-5387
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Country | US
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Telephone | 315-786-1924
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Fax | 315-786-0823
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Provider Business Mailing Address
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Address Line | 19472 US ROUTE 11 STE N101
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City | WATERTOWN
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State | NY
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Zip | 13601-5387
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Country | US
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Telephone | 315-786-1924
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Fax | 315-786-0823
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Authorized Official
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Title or Position | PRESIDENT
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Name | CATHERINE M O'BRIEN
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Credential | FNP
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Telephone | 315-786-1924
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 363LF0000X
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Taxonomy Name | Family Nurse Practitioner
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License Number |
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License Number State | NY
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