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General NPI Number Information
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NPI Number | 1881433530
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Entity Type | Individual
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Provider Name | ALISHA MARIE WATERSTRIPE PMHNP
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Gender | Female
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Dates
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Enumeration Date | 05/22/2024
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Last Update Date | 05/22/2024
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Provider Practice Location Address
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Address Line | 600 E GENESEE ST STE 130
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City | SYRACUSE
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State | NY
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Zip | 13202-3101
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Country | US
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Telephone | 315-464-2689
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Fax |
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Provider Business Mailing Address
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Address Line | 5892 SUTTON DR
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City | CICERO
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State | NY
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Zip | 13039-9545
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Country | US
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Telephone | 315-278-6813
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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 | 363LP0808X
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Taxonomy Name | Psychiatric/Mental Health Nurse Practitioner
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License Number | 405835
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License Number State | NY
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