MEDICARE: KRISTIN DEANNE TOOKER FNP

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	363LF0000X	Family Nurse Practitioner	F333736	NY

General Provider Information

NPI Number	:	1316004153
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	KRISTIN DEANNE TOOKER FNP

Provider Business Mailing Address
First Line	:	PO BOX 2003
Second Line	:
City	:	EAST SYRACUSE
State	:	NY
Zip	:	13057-4503
Country	:	US
Telephone Number	:	315-446-3904
Fax Number	:	315-445-2936

Provider Business Practice Location Address
First Line	:	221 BROAD ST
Second Line	:	SUITE 201
City	:	ONEIDA
State	:	NY
Zip	:	13421-2178
Country	:	US
Telephone Number	:	315-363-5421
Fax Number	:	315-363-5472

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

Provider Enumeration Date	:	01/02/2007
Last Update Date	:	05/27/2010

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