Provider Demographics
NPI:1134151848
Name:STALTERI, MARIANNE L (CNM/NP)
Entity type:Individual
Prefix:
First Name:MARIANNE
Middle Name:L
Last Name:STALTERI
Suffix:
Gender:F
Credentials:CNM/NP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1656 CHAMPLIN AVE
Mailing Address - Street 2:OB CARE CENTER
Mailing Address - City:NEW HARTFORD
Mailing Address - State:NY
Mailing Address - Zip Code:13413-1068
Mailing Address - Country:US
Mailing Address - Phone:315-624-6241
Mailing Address - Fax:315-624-6395
Practice Address - Street 1:1656 CHAMPLIN AVE
Practice Address - Street 2:OB CARE CENTER
Practice Address - City:NEW HARTFORD
Practice Address - State:NY
Practice Address - Zip Code:13413-1068
Practice Address - Country:US
Practice Address - Phone:315-624-6241
Practice Address - Fax:315-624-6395
Is Sole Proprietor?:No
Enumeration Date:2006-07-06
Last Update Date:2016-09-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY000765367A00000X
NY36 360394363LX0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes367A00000XPhysician Assistants & Advanced Practice Nursing ProvidersAdvanced Practice Midwife
No363LX0001XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerObstetrics & Gynecology
Provider Identifiers
StateIdentifier IDID TypeIssuer
NYJ400060926Medicare UPIN