Individual
DENISE HUERTA
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
NPP
Contact information
Practice address
USA MEDDAC, 11050 MOUNT BELVEDERE BLVD, FORT DRUM, NY 13602
(315) 772-0215
Mailing address
USA MEDDAC, 11050, FORT DRUM, NY 13602
(315) 772-0215
Taxonomy
Speciality
Code
Description
License number
State
363LP0808X
Psychiatric/Mental Health Nurse Practitioner
Primary
0F400293
NY
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
RA6439
MEDICARE
NY
Enumeration date
07/18/2006
Last updated
12/16/2021
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