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General NPI Number Information
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NPI Number | 1871716282
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Entity Type | Individual
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Provider Name | JANE F. GOTTHARDT N. P.
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Gender | Female
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Dates
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Enumeration Date | 04/11/2007
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Last Update Date | 07/19/2023
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Provider Practice Location Address
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Address Line | 2 TITUS PL
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City | WALTON
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State | NY
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Zip | 13856-1455
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Country | US
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Telephone | 607-865-2100
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Fax |
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Provider Business Mailing Address
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Address Line | 1122 KERRYVILLE RD
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City | HANCOCK
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State | NY
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Zip | 13783-3900
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Country | US
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Telephone | 607-422-7656
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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 | 163W00000X
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Taxonomy Name | Registered Nurse
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License Number | 365737-01
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License Number State | NY
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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 | F331819-01
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License Number State | NY
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