Healthcare Provider Details

I. General information

NPI: 1821924655
Provider Name (Legal Business Name): RACHEL LEE VREDENBURG
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/19/2026
Last Update Date: 06/19/2026
Certification Date: 06/19/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

301 PROSPECT AVE
SYRACUSE NY
13203-1899
US

IV. Provider business mailing address

301 PROSPECT AVE
SYRACUSE NY
13203-1899
US

V. Phone/Fax

Practice location:
  • Phone: 315-882-1251
  • Fax:
Mailing address:
  • Phone: 315-882-1251
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LP2300X
TaxonomyPrimary Care Nurse Practitioner
License Number359947
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: