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General NPI Number Information
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NPI Number | 1669746301
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Entity Type | Individual
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Provider Name | SUZANNA E WESER FNP
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Gender | Female
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Dates
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Enumeration Date | 02/27/2012
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Last Update Date | 12/21/2022
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Provider Practice Location Address
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Address Line | 4425 OLD RIDGE RD
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City | WILLIAMSON
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State | NY
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Zip | 14589-9363
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Country | US
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Telephone | 315-483-3280
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Fax | 315-589-4893
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Provider Business Mailing Address
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Address Line | 1200 DRIVING PARK AVE
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City | NEWARK
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State | NY
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Zip | 14513-1057
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Country | US
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Telephone | 315-332-2406
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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 | 337182
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License Number State | NY
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Taxonomy #2
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Taxonomy Code | 163W00000X
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Taxonomy Name | Registered Nurse
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License Number | 616634
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License Number State | NY
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