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NPI Code Detail

MEDICARE: DEBRA TIETJEN RN

MEDICARE: DEBRA TIETJEN RN
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
1163W00000XRegistered Nurse437682NY

General Provider Information

NPI Number : 1760059034
Entity Type Code : Individual
Provider Name (Legal Business Name) : DEBRA TIETJEN RN
Provider Business Mailing Address
First Line : 35 TAMARACK DR
Second Line :
City : DELMAR
State : NY
Zip : 12054-2919
Country : US
Telephone Number : 518-810-8751
Fax Number :
Provider Business Practice Location Address
First Line : 1121 FOREST RD
Second Line :
City : SCHENECTADY
State : NY
Zip : 12303-1219
Country : US
Telephone Number : 518-370-8182
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 06/07/2021
Last Update Date : 06/07/2021

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