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Individual

BRENDA J ROSE

Active
Sole proprietor
No

Provider details

NPI number
Gender
F
Credential
FNP

Contact information

Practice address
1000 E GENESEE ST, STE 300, SYRACUSE, NY 13210-1892
(315) 471-1044
(315) 474-4312
Mailing address
1000 E GENESEE ST, STE 300, SYRACUSE, NY 13210-1892
(315) 471-1044
(315) 474-4312

Taxonomy

Speciality
Code
Description
License number
State
207Q00000X
Family Medicine Physician
F334045
NY
363L00000X
Nurse Practitioner
F334045
NY
363LA2200X
Adult Health Nurse Practitioner
Primary
F334045
NY

Other

Other identifiers
Code
Description
Identifier
Issuer
State
05
02593222
NY
Enumeration date
09/30/2005
Last updated
11/11/2010
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