Healthcare Provider Details

I. General information

NPI: 1558979229
Provider Name (Legal Business Name): ADRIANNE AMANDA ANDERSON FNP-C
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 07/20/2020
Last Update Date: 10/04/2023
Certification Date: 10/04/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1 ATWELL RD
COOPERSTOWN NY
13326-1394
US

IV. Provider business mailing address

1 ATWELL RD
COOPERSTOWN NY
13326-1394
US

V. Phone/Fax

Practice location:
  • Phone: 607-547-3336
  • Fax: 607-547-3891
Mailing address:
  • Phone: 607-547-3456
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code363L00000X
TaxonomyNurse Practitioner
License NumberRN224714
License Number StateGA
# 2
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number347659
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: