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General NPI Number Information
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NPI Number | 1023111978
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Entity Type | Individual
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Provider Name | THERESA D FEOLA NP
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Gender | Female
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Dates
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Enumeration Date | 09/06/2006
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Last Update Date | 07/08/2007
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Provider Practice Location Address
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Address Line | 750 E ADAMS ST CIM POB SUITE 304
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City | SYRACUSE
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State | NY
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Zip | 13210
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Country | US
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Telephone | 315-464-5533
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Fax | 315-464-5579
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Provider Business Mailing Address
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Address Line | 2294 POMPEY HOLLOW RD
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City | CAZENOVIA
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State | NY
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Zip | 13035
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Country | US
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Telephone | 315-662-7160
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 363LF0000X
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Taxonomy Name | Family Nurse Practitioner
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License Number | 332278
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License Number State | NY
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