Individual
MOE MOE
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Contact information
Practice address
600 E GENESEE ST STE 217, SYRACUSE, NY 13202-3108
(315) 464-3265
(315) 464-3282
Mailing address
719 HARRISON ST, SYRACUSE, NY 13210-2695
(315) 464-3265
(315) 464-3282
Taxonomy
Speciality
Code
Description
License number
State
363LP0808X
Psychiatric/Mental Health Nurse Practitioner
Primary
F406139-01
NY
Other
Enumeration date
04/01/2024
Last updated
08/13/2024
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