Provider Demographics
NPI:1588630164
Name:MAKOWIEC, JUDITH A N (FNP)
Entity Type:Individual
Prefix:
First Name:JUDITH
Middle Name:A N
Last Name:MAKOWIEC
Suffix:
Gender:F
Credentials:FNP
Other - Prefix:
Other - First Name:JUDITH
Other - Middle Name:A
Other - Last Name:NEILSON
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:NP
Mailing Address - Street 1:1270 BELMONT AVE
Mailing Address - Street 2:
Mailing Address - City:SCHENECTADY
Mailing Address - State:NY
Mailing Address - Zip Code:12308-2104
Mailing Address - Country:US
Mailing Address - Phone:518-386-3539
Mailing Address - Fax:518-382-4570
Practice Address - Street 1:25 OAK TREE LN
Practice Address - Street 2:
Practice Address - City:TROY
Practice Address - State:NY
Practice Address - Zip Code:12180-6980
Practice Address - Country:US
Practice Address - Phone:518-279-3501
Practice Address - Fax:
Is Sole Proprietor?:Not Answered
Enumeration Date:2006-02-24
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY330242363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY01993640Medicaid
NYQ11653Medicare UPIN
NYRA1330Medicare ID - Type Unspecified