Individual
TRACY CANESTARO
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
RN
Contact information
Practice address
100 WASHINGTON ST, ELMIRA, NY 14901
(607) 737-4784
Mailing address
100 WASHINGTON ST, ELMIRA, NY 14901-2849
Taxonomy
Speciality
Code
Description
License number
State
163WP0808X
Psychiatric/Mental Health Registered Nurse
Primary
372668-1
NY
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
1093223869
—
NY
Enumeration date
01/16/2018
Last updated
06/07/2018
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