Healthcare Provider Details

I. General information

NPI: 1982197711
Provider Name (Legal Business Name): ANNDREA BOHN FNP-C
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 06/06/2018
Last Update Date: 04/24/2025
Certification Date: 04/24/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

400 PLAZA DR STE C
VESTAL NY
13850-3648
US

IV. Provider business mailing address

24 STACY DR
BINGHAMTON NY
13905-6043
US

V. Phone/Fax

Practice location:
  • Phone: 607-237-0065
  • Fax: 888-832-4418
Mailing address:
  • Phone: 607-760-9015
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number348172
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: