Provider Demographics
NPI:1912126947
Name:TSCHUDI, VICKY RIDLEY (RN ANP)
Entity Type:Individual
Prefix:
First Name:VICKY
Middle Name:RIDLEY
Last Name:TSCHUDI
Suffix:
Gender:F
Credentials:RN ANP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:5320 AMALFI DR
Mailing Address - Street 2:
Mailing Address - City:CLAY
Mailing Address - State:NY
Mailing Address - Zip Code:13041
Mailing Address - Country:US
Mailing Address - Phone:315-474-1561
Mailing Address - Fax:315-422-0433
Practice Address - Street 1:918 JAMES ST
Practice Address - Street 2:
Practice Address - City:SYRACUSE
Practice Address - State:NY
Practice Address - Zip Code:13203-2593
Practice Address - Country:US
Practice Address - Phone:315-474-1561
Practice Address - Fax:315-422-0433
Is Sole Proprietor?:No
Enumeration Date:2007-04-25
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
NYF3014701363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner
Provider Identifiers
StateIdentifier IDID TypeIssuer
S27344Medicare UPIN
N80073Medicare ID - Type Unspecified