Provider Demographics
NPI:1093148355
Name:MCGIVNEY-WOLTNER, EMMA JANE
Entity Type:Individual
Prefix:
First Name:EMMA
Middle Name:JANE
Last Name:MCGIVNEY-WOLTNER
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:187 PLEASANT ST
Mailing Address - Street 2:
Mailing Address - City:KEESVILLE
Mailing Address - State:NY
Mailing Address - Zip Code:12944
Mailing Address - Country:US
Mailing Address - Phone:518-834-7071
Mailing Address - Fax:
Practice Address - Street 1:187 PLEASANT ST
Practice Address - Street 2:
Practice Address - City:KEESEVILLE
Practice Address - State:NY
Practice Address - Zip Code:12944-3733
Practice Address - Country:US
Practice Address - Phone:518-834-7071
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2013-08-09
Last Update Date:2022-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY174400000X
174400000X
NY143669861174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist