Individual
MATTIE M VANGLYNN
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
RNNP
Contact information
Practice address
550 HARRISON ST, STE 130, SYRACUSE, NY 13202-3064
(315) 464-4472
Mailing address
550 HARRISON ST, STE 130, SYRACUSE, NY 13202-3064
(315) 464-4472
Taxonomy
Speciality
Code
Description
License number
State
363LA2200X
Adult Health Nurse Practitioner
Primary
203991
NY
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
02058735
—
NY
Enumeration date
06/16/2005
Last updated
07/13/2009
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