Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 363LA2100X | Nurse Practitioner - Acute Care | MP0528363 | NY |
NPI | 1003938895 |
---|---|
Provider Name | Theresa M Principato |
First Address | Syracuse, NY 13208-1850 |
Second Address | Syracuse, NY 13210-1687 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 04/04/2007 |
Last Update Date | 08/07/2007 |