Healthcare Provider Details

I. General information

NPI: 1528553336
Provider Name (Legal Business Name): KYRA DANNEKER NPP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/25/2018
Last Update Date: 06/25/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

750 E ADAMS ST
SYRACUSE NY
13210-1834
US

IV. Provider business mailing address

225 WILKINSON ST APT 302
SYRACUSE NY
13204-2478
US

V. Phone/Fax

Practice location:
  • Phone: 315-464-2500
  • Fax:
Mailing address:
  • Phone: 814-933-9887
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LP0808X
TaxonomyPsychiatric/Mental Health Nurse Practitioner
License Number402407
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: