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General NPI Number Information
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NPI Number | 1992242663
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Entity Type | Organization
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Legal Business Name | PREVENTIVE FAMILY HEALTHCARE FNPC, PLLC
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Dates
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Enumeration Date | 01/19/2017
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Last Update Date | 01/19/2017
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Provider Practice Location Address
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Address Line | 247 E MAIN ST
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City | ELBRIDGE
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State | NY
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Zip | 13060-8706
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Country | US
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Telephone | 315-689-0001
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Fax | 315-277-5311
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Provider Business Mailing Address
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Address Line | 247 E MAIN ST
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City | ELBRIDGE
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State | NY
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Zip | 13060-8706
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Country | US
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Telephone | 315-689-0001
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Fax | 315-277-5311
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Authorized Official
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Title or Position | FAMILY NURSE PRACTIONER
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Name | NICHOLAS SCOT GILFUS
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Credential | FNP-C
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Telephone | 315-689-0001
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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 | 339935
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License Number State | NY
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