Individual
MS. ANNELIESE PROVOST
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
F.N.P.
Contact information
Practice address
4164 ROUTE 2, CROPSEYVILLE, NY 12052
(518) 213-0450
Mailing address
711 TROY SCHENECTADY RD, SUITE 203, LATHAM, NY 12110-2442
(518) 782-3700
Taxonomy
Speciality
Code
Description
License number
State
363LF0000X
Family Nurse Practitioner
Primary
340586
NY
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
04591517
—
NY
Enumeration date
09/26/2016
Last updated
01/19/2017
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