Healthcare Provider Details

I. General information

NPI: 1275529950
Provider Name (Legal Business Name): LINDA ANNE PRYOR FNP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: LINDA ANNE PRYOR MSN FNP

II. Dates (important events)

Enumeration Date: 09/27/2005
Last Update Date: 03/07/2023
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1020 7TH NORTH ST STE 220
LIVERPOOL NY
13088-6192
US

IV. Provider business mailing address

1020 7TH NORTH ST STE 220
LIVERPOOL NY
13088-6192
US

V. Phone/Fax

Practice location:
  • Phone: 315-451-3906
  • Fax: 315-451-8913
Mailing address:
  • Phone: 315-451-3906
  • Fax: 315-451-8913

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License NumberF333041 1
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: