Healthcare Provider Details

I. General information

NPI: 1427373448
Provider Name (Legal Business Name): PHYLLIS ELIZABETH CREAMER RN
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 04/01/2010
Last Update Date: 04/01/2010
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1330 E WASHINGTON ST
SYRACUSE NY
13210-1173
US

IV. Provider business mailing address

1330 E WASHINGTON ST
SYRACUSE NY
13210-1173
US

V. Phone/Fax

Practice location:
  • Phone: 315-426-5950
  • Fax: 315-426-5995
Mailing address:
  • Phone: 315-426-5950
  • Fax: 315-426-5995

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code163WP0809X
TaxonomyAdult Psychiatric/Mental Health Registered Nurse
License Number379334
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: