Basic Information
| Provider Information | |||||||||
| NPI: | 1114659778 | ||||||||
| EntityType: | 2 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | COUNTY OF LEWIS | ||||||||
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| Mailing Information | |||||||||
| Address1: | 7785 N STATE ST STE 2 | ||||||||
| Address2: | |||||||||
| City: | LOWVILLE | ||||||||
| State: | NY | ||||||||
| PostalCode: | 133671229 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 3153765453 | ||||||||
| FaxNumber: | 3153767013 | ||||||||
| Practice Location | |||||||||
| Address1: | 7395 EAST RD | ||||||||
| Address2: | |||||||||
| City: | LOWVILLE | ||||||||
| State: | NY | ||||||||
| PostalCode: | 133671590 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 3153765453 | ||||||||
| FaxNumber: | 3153767013 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 06/30/2022 | ||||||||
| LastUpdateDate: | 06/30/2022 | ||||||||
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| AuthorizedOfficialLastName: | WAITE | ||||||||
| AuthorizedOfficialFirstName: | ASHLEY | ||||||||
| AuthorizedOfficialMiddleName: | |||||||||
| AuthorizedOfficialTitleorPosition: | DIRECTOR OF PUBLIC HEALTH | ||||||||
| AuthorizedOfficialTelephone: | 3153765453 | ||||||||
| IsSoleProprietor: | |||||||||
| IsOrganizationSubpart: | N | ||||||||
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| AuthorizedOfficialNamePrefix: | MRS. | ||||||||
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| AuthorizedOfficialCredential: | RN, BSN, MPH | ||||||||
| NPICertificationDate: | 06/22/2022 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 251K00000X | Y | Agencies | Public Health or Welfare |
No ID Information.