NORTHERN NURSE PRACTITIONERS - FAMILY HEALTH PLLC NPI 1114147311

NPI Information

  • NPI: 1114147311
  • Provider Name: NORTHERN NURSE PRACTITIONERS - FAMILY HEALTH PLLC
  • Classification: Nurse Practitioner - 363LF0000X
  • Specialization: Family
  • Entity Type: Organization
  • CLIA Number: 33D1033011
  • Address: 19472 US ROUTE 11 STE N101
    WATERTOWN, NY
    ZIP 13601
  • Phone: (315) 786-1924

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NPI Details

NORTHERN NURSE PRACTITIONERS - FAMILY HEALTH PLLC is a family nurse practitioner in Watertown, NY. NORTHERN NURSE PRACTITIONERS - FAMILY HEALTH PLLC NPI is 1114147311. The provider is registered as an organization entity type and is a single specialty group.

The provider's business location address is:

19472 US ROUTE 11 STE N101
WATERTOWN, NY
ZIP 13601-387
Phone: (315) 786-1924
Fax: (315) 786-0823

The provider's authorized official is Catherine M O'brien .
The authorized official title is President and has the following contact phone number (315) 786-1924.

The CLIA number assigned to this NPI record is 33D1033011 - physician office with a certificate type of Certificate for Provider-Performed Microscopy Procedures (PPMP).

The enumeration date for this NPI number is 4/27/2007 and was last updated on 9/30/2020.

Taxonomy Codes

The NPI record includes the healthcare provider taxonomy classification, state license number and state of licensure. The following information regarding the scope of practice of this provider is available:

No. Taxonomy Code Taxonomy Clasification Taxonomy Specialization License Number License State Primary
1363LF0000XNurse PractitionerFamilyNEW YORKYes

Other Identifiers

The following information regarding additional identifiers associated to this NPI record includes the other identifier number, identifier type, identifier state and issuer.

No. Other Provider Identifier Other Provider Identifier Type Other Provider Identifier State Other Provider Identifier Issuer
1CBCCMEDICAIDNEW YORK

What is NPI?

NPI stands for National Provider Identifier. The NPI is a 10-digit identification number that is completely unique. The NPI number by itself does not contain any identifiable information such as a provider’s speciality or location. The NPI is assigned to individuals or organizacions for their lifespan and it is independent of key provider information type updates like a change of practices, location or speciality.

This page was last updated on: 3/30/2025

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