Individual
BRANDY LEE WADSWORTH
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Contact information
Practice address
79 NORTH ST, GRANVILLE, NY 12832
(518) 642-0612
(518) 642-0693
Mailing address
100 PARK ST, GLENS FALLS, NY 12801-4447
(518) 926-6992
(518) 926-6983
Taxonomy
Speciality
Code
Description
License number
State
163W00000X
Registered Nurse
597823
NY
363LP0808X
Psychiatric/Mental Health Nurse Practitioner
Primary
402434
NY
Other
Enumeration date
06/05/2018
Last updated
06/29/2018
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