Individual
BRENDA LEPAGE
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
NURSE PRACTITIONER
Contact information
Practice address
133 PARK ST, MALONE, NY 12953-1220
(518) 856-0044
(518) 856-0088
Mailing address
42 BOWEN RD, NORTH BANGOR, NY 12966-2323
(518) 529-7414
Taxonomy
Speciality
Code
Description
License number
State
363LF0000X
Family Nurse Practitioner
Primary
334946
NY
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
RB1158
ALICE HYDE MEDICAL CENTER
NY
Enumeration date
07/27/2006
Last updated
08/06/2008
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