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General NPI Number Information
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NPI Number | 1740549971
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Entity Type | Organization
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Legal Business Name | NORTH COUNTRY MIDWIFERY, PLLC
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Dates
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Enumeration Date | 05/08/2012
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Last Update Date | 07/26/2016
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Provider Practice Location Address
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Address Line | 18564 US ROUTE 11 SUITE 4
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City | WATERTOWN
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State | NY
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Zip | 13601-5900
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Country | US
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Telephone | 315-681-6502
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Fax | 315-681-6716
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Provider Business Mailing Address
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Address Line | 18564 US ROUTE 11 SUITE 4
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City | WATERTOWN
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State | NY
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Zip | 13601-5900
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Country | US
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Telephone | 315-681-6502
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Fax | 315-681-6716
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Authorized Official
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Title or Position | OWNER
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Name | JOYCE M WILDER
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Credential | CNM, WHNP
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Telephone | 315-408-2851
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 363LW0102X
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Taxonomy Name | Women's Health Nurse Practitioner
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License Number | 420516
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License Number State | NY
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Taxonomy #2
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Taxonomy Code | 367A00000X
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Taxonomy Name | Advanced Practice Midwife
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License Number | 000546
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License Number State | NY
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