Healthcare Provider Details

I. General information

NPI: 1699798892
Provider Name (Legal Business Name): CATHLEEN C FREY CRNA
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/26/2006
Last Update Date: 03/14/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4900 BROAD RD
SYRACUSE NY
13215
US

IV. Provider business mailing address

PO BOX 2000
EAST SYRACUSE NY
13057-9926
US

V. Phone/Fax

Practice location:
  • Phone: 315-492-5522
  • Fax: 315-492-5339
Mailing address:
  • Phone: 315-362-5129
  • Fax: 315-362-5179

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code163WP0000X
TaxonomyPain Management Registered Nurse
License Number379642-1
License Number StateNY
# 2
Primary TaxonomyY
Taxonomy Code367500000X
TaxonomyCertified Registered Nurse Anesthetist
License Number379642
License Number StateNY
# 3
Primary TaxonomyN
Taxonomy Code163WP0000X
TaxonomyPain Management Registered Nurse
License Number379642
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: