Provider Demographics
NPI:1417044116
Name:VALLANDIGHAM, NICOLETTE D (CNM MSN)
Entity Type:Individual
Prefix:
First Name:NICOLETTE
Middle Name:D
Last Name:VALLANDIGHAM
Suffix:
Gender:F
Credentials:CNM MSN
Other - Prefix:
Other - First Name:NICOLETTE
Other - Middle Name:D
Other - Last Name:LENG
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:1001 WEST STREET
Mailing Address - Street 2:CARTHAGE AREA HOSPITAL
Mailing Address - City:CARTHAGE
Mailing Address - State:NY
Mailing Address - Zip Code:13619
Mailing Address - Country:US
Mailing Address - Phone:315-493-3100
Mailing Address - Fax:315-493-3113
Practice Address - Street 1:1001 WEST ST
Practice Address - Street 2:CARTHAGE AREA HOSPITAL
Practice Address - City:CARTHAGE
Practice Address - State:NY
Practice Address - Zip Code:13619-9703
Practice Address - Country:US
Practice Address - Phone:315-493-3100
Practice Address - Fax:315-493-3113
Is Sole Proprietor?:No
Enumeration Date:2006-10-06
Last Update Date:2013-05-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NYF001048367A00000X
MDR186685367A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes367A00000XPhysician Assistants & Advanced Practice Nursing ProvidersAdvanced Practice Midwife
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY00310852Medicaid