Healthcare Provider Details

I. General information

NPI: 1285415240
Provider Name (Legal Business Name): KIMBERLY VUOCOLO DNP, AGNP-BC, RN
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 10/06/2023
Last Update Date: 10/11/2023
Certification Date: 10/11/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5008 BRITTONFIELD PKWY
EAST SYRACUSE NY
13057-9248
US

IV. Provider business mailing address

5008 BRITTONFIELD PKWY
EAST SYRACUSE NY
13057-9248
US

V. Phone/Fax

Practice location:
  • Phone: 315-472-7504
  • Fax:
Mailing address:
  • Phone: 315-472-7504
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LA2200X
TaxonomyAdult Health Nurse Practitioner
License Number309977
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: