Provider Demographics
NPI:1891559878
Name:LIDDLE, ANITA M (NPP)
Entity type:Individual
Prefix:MRS
First Name:ANITA
Middle Name:M
Last Name:LIDDLE
Suffix:
Gender:F
Credentials:NPP
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Mailing Address - Street 1:5 HEMPHILL PLACE
Mailing Address - Street 2:SUITE 121
Mailing Address - City:MALTA
Mailing Address - State:NY
Mailing Address - Zip Code:12020
Mailing Address - Country:US
Mailing Address - Phone:518-289-5072
Mailing Address - Fax:518-289-5225
Practice Address - Street 1:2310 NOTT STREET EAST
Practice Address - Street 2:SUITE 3
Practice Address - City:NISKAYUNA
Practice Address - State:NY
Practice Address - Zip Code:12309
Practice Address - Country:US
Practice Address - Phone:518-374-6263
Practice Address - Fax:518-289-5225
Is Sole Proprietor?:Yes
Enumeration Date:2024-02-09
Last Update Date:2024-07-29
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Provider Licenses
StateLicense IDTaxonomies
NYF405632-01363LP0808X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP0808XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPsychiatric/Mental Health