Individual
KATHLEEN DANIELLE ENNIS
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
NP
Contact information
Practice address
4900 BROAD RD, SYRACUSE, NY 13215-2265
(315) 492-5011
Mailing address
38 SENECA ST, BALDWINSVILLE, NY 13027
Taxonomy
Speciality
Code
Description
License number
State
163WN0002X
Neonatal Intensive Care Registered Nurse
773322
NY
363LP0200X
Pediatric Nurse Practitioner
Primary
383572
NY
Other
Enumeration date
05/06/2021
Last updated
06/15/2023
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