Healthcare Provider Details

I. General information

NPI: 1174771208
Provider Name (Legal Business Name): CYNTHIA MARIE LAW ANP, C.
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 09/03/2008
Last Update Date: 04/29/2022
Certification Date: 04/29/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

7845 ROME WESTERNVILLE RD
ROME NY
13440-2202
US

IV. Provider business mailing address

445 FACTORY ST
WATERTOWN NY
13601-2729
US

V. Phone/Fax

Practice location:
  • Phone: 315-337-2500
  • Fax: 855-667-1414
Mailing address:
  • Phone: 315-782-4207
  • Fax: 315-782-8699

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code363LA2200X
TaxonomyAdult Health Nurse Practitioner
License NumberF30364-01
License Number StateNY
# 2
Primary TaxonomyN
Taxonomy Code363LA2200X
TaxonomyAdult Health Nurse Practitioner
License NumberF3030064-2
License Number StateNY
# 3
Primary TaxonomyY
Taxonomy Code363LA2200X
TaxonomyAdult Health Nurse Practitioner
License NumberF303064
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: