Healthcare Provider Details

I. General information

NPI: 1184767972
Provider Name (Legal Business Name): JOYCE LINNENBACH NP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 02/14/2007
Last Update Date: 03/19/2014
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

301 PROSPECT AVE PRIMARY CARE CTR-MAIN CAMPUS STE 706
SYRACUSE NY
13203-1807
US

IV. Provider business mailing address

301 PROSPECT AVE PRIMARY CARE CTR/POB STE 706
SYRACUSE NY
13203-1807
US

V. Phone/Fax

Practice location:
  • Phone: 315-703-5200
  • Fax: 315-703-5201
Mailing address:
  • Phone: 315-703-5200
  • Fax: 315-703-5201

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LX0001X
TaxonomyObstetrics & Gynecology Nurse Practitioner
License Number420082
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: