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General NPI Number Information
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NPI Number | 1891559878
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Entity Type | Individual
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Provider Name | ANITA M LIDDLE NPP
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Gender | Female
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Dates
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Enumeration Date | 02/09/2024
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Last Update Date | 07/29/2024
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Provider Practice Location Address
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Address Line | 2310 NOTT STREET EAST SUITE 3
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City | NISKAYUNA
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State | NY
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Zip | 12309
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Country | US
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Telephone | 518-374-6263
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Fax | 518-289-5225
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Provider Business Mailing Address
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Address Line | 5 HEMPHILL PLACE SUITE 121
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City | MALTA
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State | NY
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Zip | 12020
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Country | US
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Telephone | 518-289-5072
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Fax | 518-289-5225
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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 | 363LP0808X
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Taxonomy Name | Psychiatric/Mental Health Nurse Practitioner
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License Number | F405632-01
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License Number State | NY
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