MEDICARE: MS. MORGAN JANESSA NEILON PMHNP-BC

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	363LP0808X	Psychiatric/Mental Health Nurse Practitioner	401348	NY

General Provider Information

NPI Number	:	1104127729
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MS. MORGAN JANESSA NEILON PMHNP-BC

Provider Business Mailing Address
First Line	:	620 ERIE BLVD W STE 204
Second Line	:
City	:	SYRACUSE
State	:	NY
Zip	:	13204-2457
Country	:	US
Telephone Number	:	315-572-0802
Fax Number	:	315-445-1201

Provider Business Practice Location Address
First Line	:	620 ERIE BLVD W
Second Line	:	SUITE 204
City	:	SYRACUSE
State	:	NY
Zip	:	13204-2445
Country	:	US
Telephone Number	:	315-445-1200
Fax Number	:	315-445-1201

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	11/12/2010
Last Update Date	:	01/03/2018

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