MEDICARE: KRISTEN ANN TYRRELL NP

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	F334097	NY

General Provider Information

NPI Number	:	1891789707
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	KRISTEN ANN TYRRELL NP

Provider Business Mailing Address
First Line	:	PO BOX 346
Second Line	:
City	:	N SYRACUSE
State	:	NY
Zip	:	13212-0346
Country	:	US
Telephone Number	:	315-458-4622
Fax Number	:	315-458-9629

Provider Business Practice Location Address
First Line	:	5180 W TAFT RD
Second Line	:
City	:	N SYRACUSE
State	:	NY
Zip	:	13212-2601
Country	:	US
Telephone Number	:	315-458-4622
Fax Number	:	315-458-9629

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

Provider Enumeration Date	:	09/07/2005
Last Update Date	:	11/10/2014

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