Individual
ANN MACWAN
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Contact information
Practice address
115 CREEK CIR, EAST SYRACUSE, NY 13057-1369
(315) 452-5800
Mailing address
115 CREEK CIR, EAST SYRACUSE, NY 13057-1369
(315) 452-5800
Taxonomy
Speciality
Code
Description
License number
State
207R00000X
Internal Medicine Physician
310379
NY
363LA2200X
Adult Health Nurse Practitioner
Primary
310379
NY
Other
Enumeration date
08/20/2021
Last updated
12/27/2021
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