Healthcare Provider Details

I. General information

NPI: 1316269830
Provider Name (Legal Business Name): BONNIE P ROSSER RN
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 02/25/2010
Last Update Date: 02/25/2010
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3300 JAMES ST SUITE 201
SYRACUSE NY
13206-2387
US

IV. Provider business mailing address

3300 JAMES ST SUITE 201
SYRACUSE NY
13206-2387
US

V. Phone/Fax

Practice location:
  • Phone: 315-437-4500
  • Fax: 315-437-1632
Mailing address:
  • Phone: 315-437-4500
  • Fax: 315-437-1632

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code163WC1500X
TaxonomyCommunity Health Registered Nurse
License Number327256-1
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: