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Contact Information

ANNELIESE PROVOST, F.N.P.
4164 ROUTE 2
CROPSEYVILLE, NY12052
 Phone: 518-213-0450
 Fax:
 Website:
 

Specialty

Taxonomy Code Specialty Code Provider Type

Family

363LF0000X 50 Nurse Practitioner
Indicates primary specialty

NPI Profile & details for ANNELIESE PROVOST · (Female)

NPI # 1184173635
Status Active
Credentials F.N.P.
Entity Individual
Enumeration date 09/26/2016
Last updated 01/19/2017 - About 9 years ago
Sole proprietor 1 No
Identifiers
  • NY License # 340586
  • NY Medicaid 04591517
Hospital affiliation(s)
  • SAMARITAN HOSPITAL - (Acute Care)
    2215 BURDETT AVENUE
    TROY, NY 12180
1 A sole proprietor/sole proprietorship is an individual, and as such, is eligible for a single NPI number. The sole proprietor must apply for the NPI number using his or her own Social Security Number (SSN), not an Employer Identification Number (EIN) even if he/she has an EIN.

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