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General NPI Number Information
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NPI Number | 1427939305
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Entity Type | Individual
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Provider Name | WILLOW MENNONE PA
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Gender | Female
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Dates
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Enumeration Date | 09/09/2025
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Last Update Date | 09/09/2025
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Provider Practice Location Address
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Address Line | 49 LAWRENCE AVE
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City | POTSDAM
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State | NY
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Zip | 13676-1889
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Country | US
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Telephone | 315-261-2153
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Fax | 315-265-2540
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Provider Business Mailing Address
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Address Line | 50 LEROY ST
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City | POTSDAM
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State | NY
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Zip | 13676-1786
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Country | US
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Telephone |
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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 | 363A00000X
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Taxonomy Name | Physician Assistant
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License Number | 034502
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License Number State | NY
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