Provider Demographics
NPI:1932295391
Name:ULDRICH, DEIRDRE ANN (FNP)
Entity Type:Individual
Prefix:MS
First Name:DEIRDRE
Middle Name:ANN
Last Name:ULDRICH
Suffix:
Gender:F
Credentials:FNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2 ASCOT PL
Mailing Address - Street 2:
Mailing Address - City:ITHACA
Mailing Address - State:NY
Mailing Address - Zip Code:14850-1072
Mailing Address - Country:US
Mailing Address - Phone:607-266-0772
Mailing Address - Fax:607-266-0176
Practice Address - Street 1:2 ASCOT PL
Practice Address - Street 2:
Practice Address - City:ITHACA
Practice Address - State:NY
Practice Address - Zip Code:14850-1072
Practice Address - Country:US
Practice Address - Phone:607-266-0772
Practice Address - Fax:607-266-0176
Is Sole Proprietor?:Yes
Enumeration Date:2006-10-05
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NYF3349651363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily