Healthcare Provider Details

I. General information

NPI: 1043319833
Provider Name (Legal Business Name): LINDA SUSAN CASEY RNNP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/21/2006
Last Update Date: 03/11/2021
Certification Date: 03/11/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

739 IRVING AVE STE 600
SYRACUSE NY
13210-1663
US

IV. Provider business mailing address

1001 W FAYETTE ST SUITE 400
SYRACUSE NY
13204-2859
US

V. Phone/Fax

Practice location:
  • Phone: 315-701-2550
  • Fax: 315-701-2551
Mailing address:
  • Phone: 315-701-2550
  • Fax: 315-701-2551

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LA2200X
TaxonomyAdult Health Nurse Practitioner
License NumberF300245-1
License Number StateNY
# 2
Primary TaxonomyN
Taxonomy Code163WN0800X
TaxonomyNeuroscience Registered Nurse
License Number364453-1
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: