Provider Demographics
NPI:1053561381
Name:ORMEL, MARIJKE B (ANP)
Entity type:Individual
Prefix:
First Name:MARIJKE
Middle Name:B
Last Name:ORMEL
Suffix:
Gender:F
Credentials:ANP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:173 KIWASSA RD
Mailing Address - Street 2:
Mailing Address - City:SARANAC LAKE
Mailing Address - State:NY
Mailing Address - Zip Code:12983-2356
Mailing Address - Country:US
Mailing Address - Phone:518-891-0078
Mailing Address - Fax:518-897-2423
Practice Address - Street 1:2233 STATE ROUTE 86
Practice Address - Street 2:
Practice Address - City:SARANAC LAKE
Practice Address - State:NY
Practice Address - Zip Code:12983-5644
Practice Address - Country:US
Practice Address - Phone:518-891-4141
Practice Address - Fax:518-897-2788
Is Sole Proprietor?:No
Enumeration Date:2008-09-23
Last Update Date:2008-10-06
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
NY304917363LA2200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LA2200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerAdult Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY141731786OtherTAX ID
NY00363213Medicaid
NY1245446533OtherGROUP NPI
NY70138AMedicare UPIN