Provider Demographics
NPI:1407856669
Name:WIANT-MASKIN, PRISCILLA LYNNE (NP)
Entity Type:Individual
Prefix:
First Name:PRISCILLA
Middle Name:LYNNE
Last Name:WIANT-MASKIN
Suffix:
Gender:F
Credentials:NP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:366 ELM AVE
Mailing Address - Street 2:
Mailing Address - City:DELMAR
Mailing Address - State:NY
Mailing Address - Zip Code:12054-9731
Mailing Address - Country:US
Mailing Address - Phone:518-475-1190
Mailing Address - Fax:
Practice Address - Street 1:1070 LUTHER RD
Practice Address - Street 2:
Practice Address - City:EAST GREENBUSH
Practice Address - State:NY
Practice Address - Zip Code:12061-4020
Practice Address - Country:US
Practice Address - Phone:518-477-7664
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2005-07-28
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NYF-331050-1363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily