Provider Demographics
NPI:1326027061
Name:OTSELIC VALLEY FAMILY HEALTH NP PC
Entity Type:Organization
Organization Name:OTSELIC VALLEY FAMILY HEALTH NP PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:FAMILY NURSE PRACTITIONER OWNER
Authorized Official - Prefix:
Authorized Official - First Name:JUDY
Authorized Official - Middle Name:A
Authorized Official - Last Name:PENDELL-MCKEE
Authorized Official - Suffix:
Authorized Official - Credentials:FNP
Authorized Official - Phone:315-653-7515
Mailing Address - Street 1:PO BOX 90
Mailing Address - Street 2:
Mailing Address - City:SOUTH OTSELIC
Mailing Address - State:NY
Mailing Address - Zip Code:13155
Mailing Address - Country:US
Mailing Address - Phone:315-653-7515
Mailing Address - Fax:315-653-7517
Practice Address - Street 1:1594 STATE HIGHWAY RTE 26
Practice Address - Street 2:
Practice Address - City:SOUTH OTSELIC
Practice Address - State:NY
Practice Address - Zip Code:13155
Practice Address - Country:US
Practice Address - Phone:315-653-7515
Practice Address - Fax:315-653-7517
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-01-11
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NYF330475363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamilyGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
73852OtherMVP
G0182787090OtherBCBS
AA0524OtherMEDICARE GROUP UPIN