Basic Information
Provider Information
NPI: 1518376292
EntityType: 1
ReplacementNPI:  
OrganizationName:  
LastName: TESI
FirstName: JULIE
MiddleName:  
NamePrefix:  
NameSuffix:  
Credential: CNM
OtherOrganizationName:  
OtherOrganizationType:  
OtherLastName:  
OtherFirstName:  
OtherMiddleName:  
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OtherCredential:  
OtherLastNameType:  
Mailing Information
Address1: 99 EAST STATE STREET
Address2: PO BOX 1250
City: GLOVERSVILLE
State: NY
PostalCode: 120780010
CountryCode: US
TelephoneNumber: 5187754360
FaxNumber: 5187735237
Practice Location
Address1: 4104 STATE HIGHWAY 30
Address2:  
City: AMSTERDAM
State: NY
PostalCode: 120106202
CountryCode: US
TelephoneNumber: 5188838624
FaxNumber: 5188838286
Other Information
ProviderEnumerationDate: 08/07/2014
LastUpdateDate: 01/21/2015
NPIDeactivationReasonCode:  
NPIDeactivationDate:  
NPIReactivationDate:  
ProviderGenderCode: F
AuthorizedOfficialLastName:  
AuthorizedOfficialFirstName:  
AuthorizedOfficialMiddleName:  
AuthorizedOfficialTitleorPosition:  
AuthorizedOfficialTelephone:  
IsSoleProprietor: N
IsOrganizationSubpart:  
ParentOrganizationLBN:  
AuthorizedOfficialNamePrefix:  
AuthorizedOfficialNameSuffix:  
AuthorizedOfficialCredential:  
NPICertificationDate:  

Taxonomy Information
TaxonomyLicenseStateSwitchTaxonomyGroupTaxonomyTypeTaxonomyClassSubSpecialty
367A00000X001634NYY Physician Assistants & Advanced Practice Nursing ProvidersAdvanced Practice Midwife 

No ID Information.


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