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General NPI Number Information
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NPI Number | 1649088865
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Entity Type | Individual
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Provider Name | ETHEL DEITZ CNP
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Gender | Female
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Dates
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Enumeration Date | 12/19/2024
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Last Update Date | 11/25/2025
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Provider Practice Location Address
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Address Line | 136 PKWY DR
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City | COBLESKILL
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State | NY
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Zip | 12043
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Country | US
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Telephone | 518-234-2555
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Fax |
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Provider Business Mailing Address
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Address Line | 1 ATWELL RD
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City | COOPERSTOWN
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State | NY
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Zip | 13326-1301
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Country | US
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Telephone | 607-547-3480
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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 | 363LF0000X
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Taxonomy Name | Family Nurse Practitioner
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License Number | 26NJ15235900
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License Number State | NJ
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Taxonomy #2
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Taxonomy Code | 363LF0000X
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Taxonomy Name | Family Nurse Practitioner
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License Number | 357908
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License Number State | NY
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