Healthcare Provider Details

I. General information

NPI: 1710482096
Provider Name (Legal Business Name): VANETTA ROSEVEAR NP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: VANETTA LUKE NP

II. Dates (important events)

Enumeration Date: 03/28/2018
Last Update Date: 03/23/2021
Certification Date: 03/23/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

160 ROBINSON ST
BINGHAMTON NY
13904-1842
US

IV. Provider business mailing address

33 LEWIS RD 2ND FL
BINGHAMTON NY
13905
US

V. Phone/Fax

Practice location:
  • Phone: 607-296-2300
  • Fax: 607-296-2287
Mailing address:
  • Phone: 607-729-8156
  • Fax: 607-729-3982

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code163W00000X
TaxonomyRegistered Nurse
License Number648837
License Number StateNY
# 2
Primary TaxonomyY
Taxonomy Code363L00000X
TaxonomyNurse Practitioner
License Number343255
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: