Provider Demographics
NPI:1275086100
Name:THERESA M. PITTMAN, ADULT NURSE PRACTITIONER, PLLC
Entity Type:Organization
Organization Name:THERESA M. PITTMAN, ADULT NURSE PRACTITIONER, PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:THERESA
Authorized Official - Middle Name:M
Authorized Official - Last Name:PITTMAN
Authorized Official - Suffix:
Authorized Official - Credentials:ANP-BC
Authorized Official - Phone:518-434-1087
Mailing Address - Street 1:16 ASPRION RD
Mailing Address - Street 2:
Mailing Address - City:GLENMONT
Mailing Address - State:NY
Mailing Address - Zip Code:12077-3300
Mailing Address - Country:US
Mailing Address - Phone:518-225-9929
Mailing Address - Fax:
Practice Address - Street 1:16 ASPRION RD
Practice Address - Street 2:
Practice Address - City:GLENMONT
Practice Address - State:NY
Practice Address - Zip Code:12077-3300
Practice Address - Country:US
Practice Address - Phone:518-225-9929
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2016-07-27
Last Update Date:2016-08-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY304380363LA2200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes363LA2200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerAdult HealthGroup - Single Specialty