Provider Demographics
NPI:1043452444
Name:ALTIDOR, MARIE ALBERTE (CRNA)
Entity type:Individual
Prefix:MS
First Name:MARIE
Middle Name:ALBERTE
Last Name:ALTIDOR
Suffix:
Gender:F
Credentials:CRNA
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Mailing Address - Street 1:6720 BERTNER AVE STE O-520
Mailing Address - Street 2:
Mailing Address - City:HOUSTON
Mailing Address - State:TX
Mailing Address - Zip Code:77030-2604
Mailing Address - Country:US
Mailing Address - Phone:832-355-2666
Mailing Address - Fax:832-355-6500
Practice Address - Street 1:736 IRVING AVE
Practice Address - Street 2:
Practice Address - City:SYRACUSE
Practice Address - State:NY
Practice Address - Zip Code:13210-1602
Practice Address - Country:US
Practice Address - Phone:315-470-7111
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2009-03-31
Last Update Date:2025-01-15
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
TX079354367500000X
WI10088-33367500000X
TXAP118085367500000X
GARN160513367500000X
MARN2314855367500000X
NY970700367500000X
TX765286367500000X
FL9217042367500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes367500000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Anesthetist, Certified Registered
Provider Identifiers
StateIdentifier IDID TypeIssuer
WI1043452444Medicaid