Basic Information
| Provider Information | |||||||||
| NPI: | 1356483812 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | RHODE | ||||||||
| FirstName: | MARGOT | ||||||||
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| Credential: | FNP | ||||||||
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| Mailing Information | |||||||||
| Address1: | 160 STONE ST | ||||||||
| Address2: | |||||||||
| City: | WATERTOWN | ||||||||
| State: | NY | ||||||||
| PostalCode: | 136013250 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 3157888065 | ||||||||
| FaxNumber: | 3157887062 | ||||||||
| Practice Location | |||||||||
| Address1: | 160 STONE ST | ||||||||
| Address2: | |||||||||
| City: | WATERTOWN | ||||||||
| State: | NY | ||||||||
| PostalCode: | 136013250 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 3157888065 | ||||||||
| FaxNumber: | 3157887062 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 02/13/2007 | ||||||||
| LastUpdateDate: | 07/08/2007 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 363LF0000X | F330047-1 | NY | Y | Physician Assistants & Advanced Practice Nursing Providers | Nurse Practitioner | Family |
ID Information
| ID | Type | State | Issuer | Description | 00583697 | 05 | NY | MEDICAID |