Provider Demographics
NPI:1629145578
Name:MOHAWK VALLEY REGISTERED PROFESSIONAL NURSE AND ADULT AND FAMILY HEALT
Entity Type:Organization
Organization Name:MOHAWK VALLEY REGISTERED PROFESSIONAL NURSE AND ADULT AND FAMILY HEALT
Other - Org Name:MOHAWK VALLEY NURSE PRACTITIONERS
Other - Org Type:Doing Business As
Authorized Official - Title/Position:MEMBER
Authorized Official - Prefix:
Authorized Official - First Name:LAURA
Authorized Official - Middle Name:LYNNE
Authorized Official - Last Name:LUKE
Authorized Official - Suffix:
Authorized Official - Credentials:NP
Authorized Official - Phone:315-733-7913
Mailing Address - Street 1:1 NOTRE DAME LN
Mailing Address - Street 2:
Mailing Address - City:UTICA
Mailing Address - State:NY
Mailing Address - Zip Code:13502-4817
Mailing Address - Country:US
Mailing Address - Phone:315-733-7913
Mailing Address - Fax:
Practice Address - Street 1:1 NOTRE DAME LN
Practice Address - Street 2:
Practice Address - City:UTICA
Practice Address - State:NY
Practice Address - Zip Code:13502-4817
Practice Address - Country:US
Practice Address - Phone:315-733-7913
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-11-29
Last Update Date:2008-10-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NYF333748-1261QP2300X
NY186525261QP2300X
NYF301845-1261QP2300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QP2300XAmbulatory Health Care FacilitiesClinic/CenterPrimary Care
Provider Identifiers
StateIdentifier IDID TypeIssuer
NYDF5144OtherRAILROAD MEDICARE