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General NPI Number Information
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NPI Number | 1366646754
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Entity Type | Individual
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Provider Name | MARTA ELAINE DOXSTADER LPN
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Gender | Female
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Dates
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Enumeration Date | 06/12/2007
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Last Update Date | 08/05/2007
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Provider Practice Location Address
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Address Line | STATE ROUTE 28
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City | WOODGATE
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State | NY
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Zip | 13494
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Country | US
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Telephone | 315-392-5600
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Fax |
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Provider Business Mailing Address
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Address Line | 9516 STATE ROUTE 274
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City | REMSEN
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State | NY
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Zip | 13438-4639
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Country | US
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Telephone | 315-865-6216
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 164W00000X
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Taxonomy Name | Licensed Practical Nurse
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License Number | 181498-1
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License Number State | NY
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