Healthcare Provider Details

I. General information

NPI: 1700077393
Provider Name (Legal Business Name): ANN M FONS FNP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/07/2007
Last Update Date: 06/23/2014
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

22571 SUMMIT DR
WATERTOWN NY
13601-7233
US

IV. Provider business mailing address

22571 SUMMIT DR
WATERTOWN NY
13601-7233
US

V. Phone/Fax

Practice location:
  • Phone: 315-782-0136
  • Fax: 315-782-7212
Mailing address:
  • Phone: 315-782-0136
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number335331
License Number StateNY
# 2
Primary TaxonomyN
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License NumberF3353311
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: