Individual
ALIDA ANNE DEJONG
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
NP
Contact information
Practice address
1045 JAMES ST, SYRACUSE, NY 13203-2730
(315) 472-4471
(315) 472-1759
Mailing address
1045 JAMES ST, SYRACUSE, NY 13203-2730
(315) 472-4471
(315) 472-1759
Taxonomy
Speciality
Code
Description
License number
State
163WG0000X
General Practice Registered Nurse
482368-1
NY
363LA2200X
Adult Health Nurse Practitioner
F302146-1
NY
363LF0000X
Family Nurse Practitioner
Primary
F333173-1
NY
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
02629216
—
NY
Enumeration date
06/16/2005
Last updated
12/01/2015
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