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General NPI Number Information
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NPI Number | 1285003376
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Entity Type | Individual
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Provider Name | EMILY CATHERINE BASTIAANSE FNP-C
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Gender | Female
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Dates
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Enumeration Date | 09/18/2015
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Last Update Date | 04/05/2021
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Provider Practice Location Address
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Address Line | 2517 VESTAL PKWY E
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City | VESTAL
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State | NY
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Zip | 13850-2020
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Country | US
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Telephone | 607-798-1452
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Fax |
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Provider Business Mailing Address
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Address Line | 1 GUTHRIE SQ
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City | SAYRE
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State | PA
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Zip | 18840-1625
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Country | US
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Telephone | 570-888-5858
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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 | 363LP2300X
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Taxonomy Name | Primary Care Nurse Practitioner
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License Number | 340003
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License Number State | NY
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