Provider Demographics
NPI:1609229707
Name:ALTEBRANDO, GRACE (RN)
Entity Type:Individual
Prefix:
First Name:GRACE
Middle Name:
Last Name:ALTEBRANDO
Suffix:
Gender:F
Credentials:RN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:11 MILE RD
Mailing Address - Street 2:
Mailing Address - City:SUFFERN
Mailing Address - State:NY
Mailing Address - Zip Code:10901-3505
Mailing Address - Country:US
Mailing Address - Phone:845-608-5035
Mailing Address - Fax:
Practice Address - Street 1:130 FISHER RD STE 3-1
Practice Address - Street 2:
Practice Address - City:BERLIN
Practice Address - State:VT
Practice Address - Zip Code:05602-9000
Practice Address - Country:US
Practice Address - Phone:802-225-7000
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2016-07-13
Last Update Date:2019-07-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY702951163W00000X
VT101-0134266363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
No163W00000XNursing Service ProvidersRegistered Nurse