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General NPI Number Information
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NPI Number | 1962514315
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Entity Type | Individual
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Provider Name | ANNE MARIE CLANCY NP
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Gender | Female
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Dates
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Enumeration Date | 08/31/2006
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Last Update Date | 08/24/2020
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Provider Practice Location Address
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Address Line | 750 E ADAMS ST CARDIOLOGY DEPT ROOME 6804
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City | SYRACUSE
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State | NY
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Zip | 13210-2306
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Country | US
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Telephone | 315-464-4262
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Fax |
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Provider Business Mailing Address
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Address Line | 251 SALINA MEADOWS PKWY STE 100
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City | SYRACUSE
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State | NY
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Zip | 13212-4516
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Country | US
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Telephone | 315-464-2014
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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 | 330092
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License Number State | NY
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