Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 363LA2200X | Nurse Practitioner - Adult Health | F301403 | NY |
NPI | 1013019264 |
---|---|
Provider Name | Mrs. Janice Morey Pedersen |
First Address | Syracuse, NY 13210-2716 |
Second Address | Syracuse, NY 13210-2716 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 01/09/2006 |
Last Update Date | 08/07/2007 |