Healthcare Provider Details

I. General information

NPI: 1538405246
Provider Name (Legal Business Name): NANCY LYNNE O'CONNOR-RYERSON NP
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 12/27/2012
Last Update Date: 12/27/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

135 STATE ST
AUBURN NY
13024-9001
US

IV. Provider business mailing address

2259 CENTER RD
SCIPIO CENTER NY
13147-4109
US

V. Phone/Fax

Practice location:
  • Phone: 315-253-8401
  • Fax: 315-255-1371
Mailing address:
  • Phone: 315-730-7815
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LA2200X
TaxonomyAdult Health Nurse Practitioner
License NumberF304050-1
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: