Healthcare Provider Details

I. General information

NPI: 1669434569
Provider Name (Legal Business Name): SUZANNE MARIE NAYLOR FNP
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 04/05/2006
Last Update Date: 03/24/2010
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

448 COUNTY ROUTE 1A
OSWEGO NY
13126
US

IV. Provider business mailing address

137 ARCADIA AVE
OSWEGO NY
13126-6147
US

V. Phone/Fax

Practice location:
  • Phone: 315-349-0215
  • Fax: 315-349-3080
Mailing address:
  • Phone: 315-532-6744
  • Fax: 315-349-3080

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License NumberF330715
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: