Healthcare Provider Details

I. General information

NPI: 1255592028
Provider Name (Legal Business Name): NANCY FORSYTH
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 06/24/2008
Last Update Date: 06/24/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

736 IRVING AVE SUITE 9100
SYRACUSE NY
13210-1687
US

IV. Provider business mailing address

736 IRVING AVE SUITE 9100
SYRACUSE NY
13210-1687
US

V. Phone/Fax

Practice location:
  • Phone: 315-470-7379
  • Fax: 315-470-2923
Mailing address:
  • Phone: 315-470-7379
  • Fax: 315-470-2923

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LN0000X
TaxonomyNeonatal Nurse Practitioner
License Number350242
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: