Individual
MRS. ELAINE MARIE TREVISANI
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
ANP
Contact information
Practice address
110 BUSINESS PARK DR, UTICA, NY 13502-6302
(315) 624-7000
Mailing address
110 BUSINESS PARK DR, UTICA, NY 13502-6302
(315) 624-7000
Taxonomy
Speciality
Code
Description
License number
State
363LA2200X
Adult Health Nurse Practitioner
Primary
F301774-1
NY
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
02642244
—
NY
Enumeration date
10/28/2005
Last updated
05/05/2011
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