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General NPI Number Information
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NPI Number | 1083267959
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Entity Type | Organization
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Legal Business Name | COMPASSIONATE PSYCHIATRIC NP CARE PLLC
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Dates
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Enumeration Date | 07/19/2019
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Last Update Date | 08/20/2019
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Provider Practice Location Address
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Address Line | 5700 W GENESEE ST STE 132
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City | CAMILLUS
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State | NY
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Zip | 13031-3212
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Country | US
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Telephone | 315-362-2540
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Fax | 315-671-1786
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Provider Business Mailing Address
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Address Line | 5700 W GENESEE ST STE 132
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City | CAMILLUS
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State | NY
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Zip | 13031-3212
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Country | US
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Telephone | 315-362-2540
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Fax | 315-671-1786
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Authorized Official
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Title or Position | OWNER/NURSE PRACTITIONER
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Name | SHELLY LYNN PETERS
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Credential | PMHNP-BC
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Telephone | 315-362-2540
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 363LP0808X
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Taxonomy Name | Psychiatric/Mental Health Nurse Practitioner
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License Number |
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License Number State |
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