Healthcare Provider Details

I. General information

NPI: 1104822675
Provider Name (Legal Business Name): DEBORAH L. SCHU RNNP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/21/2005
Last Update Date: 10/31/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2949 ERIE BLVD E SUITE 110
SYRACUSE NY
13224-1442
US

IV. Provider business mailing address

2949 ERIE BLVD EAST SUITE 110
SYRACUSE NY
13224
US

V. Phone/Fax

Practice location:
  • Phone: 315-424-1430
  • Fax: 315-424-1779
Mailing address:
  • Phone: 315-424-1430
  • Fax: 315-424-1779

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LA2200X
TaxonomyAdult Health Nurse Practitioner
License NumberF300287
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: