Provider Demographics
NPI:1265789499
Name:ULRICH, CLARA HERMINE
Entity type:Individual
Prefix:MISS
First Name:CLARA
Middle Name:HERMINE
Last Name:ULRICH
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:109 MOHAWK AVE
Mailing Address - Street 2:
Mailing Address - City:SCOTIA
Mailing Address - State:NY
Mailing Address - Zip Code:12302-2247
Mailing Address - Country:US
Mailing Address - Phone:518-370-1515
Mailing Address - Fax:
Practice Address - Street 1:109 MOHAWK AVE
Practice Address - Street 2:
Practice Address - City:SCOTIA
Practice Address - State:NY
Practice Address - Zip Code:12302-2247
Practice Address - Country:US
Practice Address - Phone:518-370-1515
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2012-08-07
Last Update Date:2012-08-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY280317-1164W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes164W00000XNursing Service ProvidersLicensed Practical Nurse
Provider Identifiers
StateIdentifier IDID TypeIssuer
1316089865OtherGENTLE HOME HEALTH CARE