Healthcare Provider Details

I. General information

NPI: 1699749523
Provider Name (Legal Business Name): CARRIE M VANGROL FNP
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 02/15/2006
Last Update Date: 11/02/2022
Certification Date: 11/02/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

425 N MAIN ST
WARSAW NY
14569-1022
US

IV. Provider business mailing address

425 N MAIN ST
WARSAW NY
14569-1022
US

V. Phone/Fax

Practice location:
  • Phone: 585-786-0333
  • Fax: 585-786-0336
Mailing address:
  • Phone: 585-786-0333
  • Fax: 585-786-0336

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License NumberF 334036-1
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: