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NPI Code Detail

MEDICARE: TERRY L PREDMORE CRNA

MEDICARE: TERRY L PREDMORE CRNA
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
1367500000XCertified Registered Nurse Anesthetist501897NY

General Provider Information

NPI Number : 1417128414
Entity Type Code : Individual
Provider Name (Legal Business Name) : TERRY L PREDMORE CRNA
Provider Business Mailing Address
First Line : PO BOX 2337
Second Line :
City : SYRACUSE
State : NY
Zip : 13220-2337
Country : US
Telephone Number : 315-422-2933
Fax Number : 315-422-3909
Provider Business Practice Location Address
First Line : 736 IRVING AVE
Second Line :
City : SYRACUSE
State : NY
Zip : 13210-1602
Country : US
Telephone Number : 315-470-7111
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 03/18/2008
Last Update Date : 06/02/2026

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