MEDICARE: ERIKA L DEMARCHE PMHNP

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
1	101YA0400X	Addiction (Substance Use Disorder) Counselor
2	363LP0808X	Psychiatric/Mental Health Nurse Practitioner	40 401703	NY

General Provider Information

NPI Number	:	1902093677
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	ERIKA L DEMARCHE PMHNP

Provider Business Mailing Address
First Line	:	110 W 6TH ST
Second Line	:
City	:	OSWEGO
State	:	NY
Zip	:	13126-2507
Country	:	US
Telephone Number	:	315-349-5511
Fax Number	:	315-326-3565

Provider Business Practice Location Address
First Line	:	98 N 2ND ST
Second Line	:
City	:	FULTON
State	:	NY
Zip	:	13069-1254
Country	:	US
Telephone Number	:	315-326-3555
Fax Number	:	315-326-3565

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	09/26/2007
Last Update Date	:	06/25/2014

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