Provider Demographics
NPI:1881720571
Name:LINCOLN-ROBERTS, ETHELMA (NP)
Entity type:Individual
Prefix:MRS
First Name:ETHELMA
Middle Name:
Last Name:LINCOLN-ROBERTS
Suffix:
Gender:F
Credentials:NP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1204 UNION ST
Mailing Address - Street 2:
Mailing Address - City:SCHENECTADY
Mailing Address - State:NY
Mailing Address - Zip Code:12308-2931
Mailing Address - Country:US
Mailing Address - Phone:518-813-2747
Mailing Address - Fax:518-280-2003
Practice Address - Street 1:600 FRANKLIN ST
Practice Address - Street 2:
Practice Address - City:SCHENECTADY
Practice Address - State:NY
Practice Address - Zip Code:12305-2100
Practice Address - Country:US
Practice Address - Phone:518-813-2747
Practice Address - Fax:518-280-2003
Is Sole Proprietor?:No
Enumeration Date:2007-02-26
Last Update Date:2012-11-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NYF304082364SA2200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes364SA2200XPhysician Assistants & Advanced Practice Nursing ProvidersClinical Nurse SpecialistAdult Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY02995513Medicaid
NY53099AMedicare PIN
NY331833Medicare Oscar/Certification