Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 363LP0808X | Nurse Practitioner - Psychiatric/Mental Health | 402630 | NY |
NPI | 1023675881 |
---|---|
Provider Name | John Justin Ringhisen |
First Address | Syracuse, NY 13202-3003 |
Second Address | Syracuse, NY 13202-3003 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 28/05/2019 |
Last Update Date | 28/05/2019 |