Healthcare Provider Details

I. General information

NPI: 1538151162
Provider Name (Legal Business Name): ANNE DENISE NEIRYNCK FNP, CDE
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/19/2005
Last Update Date: 07/17/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

404 N CAYUGA ST
ITHACA NY
14850-4219
US

IV. Provider business mailing address

404 N CAYUGA ST
ITHACA NY
14850-4219
US

V. Phone/Fax

Practice location:
  • Phone: 607-277-0969
  • Fax: 607-277-3242
Mailing address:
  • Phone: 607-277-0969
  • Fax: 607-277-3242

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207RE0101X
TaxonomyEndocrinology, Diabetes & Metabolism Physician
License NumberF332267
License Number StateNY
# 2
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License NumberF332267
License Number StateNY
# 3
Primary TaxonomyN
Taxonomy Code163WD0400X
TaxonomyDiabetes Educator Registered Nurse
License Number2222-0372
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: