Provider Demographics
NPI:1326091257
Name:RIEDE, BARBARA L (FNP)
Entity Type:Individual
Prefix:
First Name:BARBARA
Middle Name:L
Last Name:RIEDE
Suffix:
Gender:F
Credentials:FNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:380 GUY PARK AVE
Mailing Address - Street 2:ST. MARY'S HEALTHCARE
Mailing Address - City:AMSTERDAM
Mailing Address - State:NY
Mailing Address - Zip Code:12010-1055
Mailing Address - Country:US
Mailing Address - Phone:518-841-7430
Mailing Address - Fax:518-841-7121
Practice Address - Street 1:380 GUY PARK AVE
Practice Address - Street 2:ST. MARY'S HEALTHCARE
Practice Address - City:AMSTERDAM
Practice Address - State:NY
Practice Address - Zip Code:12010-1055
Practice Address - Country:US
Practice Address - Phone:518-841-7430
Practice Address - Fax:518-841-7121
Is Sole Proprietor?:No
Enumeration Date:2006-05-19
Last Update Date:2014-07-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PASP003757B363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY02554025Medicaid
NYRA7468Medicare ID - Type UnspecifiedUPSTATE
NY02554025Medicaid