Provider Demographics
NPI:1356483812
Name:RHODE, MARGOT (FNP)
Entity Type:Individual
Prefix:
First Name:MARGOT
Middle Name:
Last Name:RHODE
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 1:160 STONE ST
Mailing Address - Street 2:
Mailing Address - City:WATERTOWN
Mailing Address - State:NY
Mailing Address - Zip Code:13601-3250
Mailing Address - Country:US
Mailing Address - Phone:315-788-8065
Mailing Address - Fax:315-788-7062
Practice Address - Street 1:160 STONE ST
Practice Address - Street 2:
Practice Address - City:WATERTOWN
Practice Address - State:NY
Practice Address - Zip Code:13601-3250
Practice Address - Country:US
Practice Address - Phone:315-788-8065
Practice Address - Fax:315-788-7062
Is Sole Proprietor?:No
Enumeration Date:2007-02-13
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NYF330047-1363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY00583697Medicaid
NYS28223Medicare UPIN
NY00583697Medicaid