Healthcare Provider Details

I. General information

NPI: 1477191708
Provider Name (Legal Business Name): STACY MARIE SALANGER
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 12/17/2019
Last Update Date: 09/23/2026
Certification Date: 09/23/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

134 HOMER AVE
CORTLAND NY
13045-1206
US

IV. Provider business mailing address

265 BROOKVIEW CENTRE WAY
KNOXVILLE TN
37919-4049
US

V. Phone/Fax

Practice location:
  • Phone: 607-756-3500
  • Fax:
Mailing address:
  • Phone: 800-342-2898
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number344442
License Number StateNY
# 2
Primary TaxonomyN
Taxonomy Code163W00000X
TaxonomyRegistered Nurse
License Number718030
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: