Individual
BILLY MANUEL
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
NURSE PRACTITIONER
Contact information
Practice address
620 ERIE BLVD W STE 302, SYRACUSE, NY 13204-2463
(315) 472-7363
Mailing address
4396 GEORGIAN CT APT 27, LIVERPOOL, NY 13090-3889
(678) 428-3647
Taxonomy
Speciality
Code
Description
License number
State
163W00000X
Registered Nurse
684280
NY
363LP0808X
Psychiatric/Mental Health Nurse Practitioner
Primary
402391
NY
Other
Enumeration date
07/30/2018
Last updated
07/30/2018
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