Individual
MRS. BOBBIE RAE FAIVUS VANGORDER
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
P.A.
Contact information
Practice address
110 W UTICA ST, OSWEGO, NY 13126-3047
(315) 349-5537
Mailing address
110 W 6TH ST, OSWEGO, NY 13126-2507
(315) 349-5511
(315) 349-5921
Taxonomy
Speciality
Code
Description
License number
State
363AM0700X
Medical Physician Assistant
Primary
014226
NY
Other
Enumeration date
10/05/2010
Last updated
03/29/2023
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