MEDICARE: VERA RATHJE ANP

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	363LA2200X	Adult Health Nurse Practitioner	F306700	NY
2	363LG0600X	Gerontology Nurse Practitioner	5011000	NC

General Provider Information

NPI Number	:	1376974865
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	VERA RATHJE ANP

Provider Business Mailing Address
First Line	:	5100 W TAFT RD STE 2G
Second Line	:
City	:	LIVERPOOL
State	:	NY
Zip	:	13088-4841
Country	:	US
Telephone Number	:	315-312-0089
Fax Number	:	315-312-0110

Provider Business Practice Location Address
First Line	:	105 COUNTY ROUTE 45A
Second Line	:	SUITE 400
City	:	OSWEGO
State	:	NY
Zip	:	13126-6673
Country	:	US
Telephone Number	:	315-312-0089
Fax Number	:	315-312-0110

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

Provider Enumeration Date	:	12/09/2013
Last Update Date	:	01/15/2026

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Directions to “ VERA RATHJE ANP” Practice Location

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