Healthcare Provider Details

I. General information

NPI: 1780191130
Provider Name (Legal Business Name): KATHYRN MARY SPINEK N.P.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 01/08/2018
Last Update Date: 01/08/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

750 E ADAMS ST
SYRACUSE NY
13210-2306
US

IV. Provider business mailing address

750 E ADAMS ST
SYRACUSE NY
13210-2306
US

V. Phone/Fax

Practice location:
  • Phone: 315-464-5940
  • Fax: 315-464-5944
Mailing address:
  • Phone: 315-464-5276
  • Fax: 315-464-5944

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363L00000X
TaxonomyNurse Practitioner
License NumberF308476-1
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: