MEDICARE: MRS. SONYA LYNNE BLACKMER 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	163W00000X	Registered Nurse	631400	NY
2	363LF0000X	Family Nurse Practitioner	F341565-1	NY

General Provider Information

NPI Number	:	1699294082
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MRS. SONYA LYNNE BLACKMER FNP

Provider Business Mailing Address
First Line	:	84 LAMPLIGHTER ACRES
Second Line	:
City	:	FORT EDWARD
State	:	NY
Zip	:	12828-9317
Country	:	US
Telephone Number	:	518-480-5870
Fax Number	:

Provider Business Practice Location Address
First Line	:	84 LAMPLIGHTER ACRES
Second Line	:
City	:	FORT EDWARD
State	:	NY
Zip	:	12828-9317
Country	:	US
Telephone Number	:	518-480-5870
Fax Number	:

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

Provider Enumeration Date	:	09/17/2017
Last Update Date	:	07/21/2022

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