Provider Demographics
NPI:1518233824
Name:ECHTNER, ALICE (LPN)
Entity Type:Individual
Prefix:
First Name:ALICE
Middle Name:
Last Name:ECHTNER
Suffix:
Gender:F
Credentials:LPN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 108
Mailing Address - Street 2:3463 STATE ROUTE 30
Mailing Address - City:FULTONHAM
Mailing Address - State:NY
Mailing Address - Zip Code:12071-0108
Mailing Address - Country:US
Mailing Address - Phone:518-827-6771
Mailing Address - Fax:
Practice Address - Street 1:3463 STATE ROUTE 30
Practice Address - Street 2:
Practice Address - City:FULTONHAM
Practice Address - State:NY
Practice Address - Zip Code:12071
Practice Address - Country:US
Practice Address - Phone:518-827-6771
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2012-03-30
Last Update Date:2012-03-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY110937-1164W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes164W00000XNursing Service ProvidersLicensed Practical Nurse