Basic Information
| Provider Information | |||||||||
| NPI: | 1306453295 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | PERSONS | ||||||||
| FirstName: | SARAH | ||||||||
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| Credential: | NP | ||||||||
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| Mailing Information | |||||||||
| Address1: | 7808 VERNON RD S | ||||||||
| Address2: | |||||||||
| City: | CICERO | ||||||||
| State: | NY | ||||||||
| PostalCode: | 130399354 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 3157087870 | ||||||||
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| Practice Location | |||||||||
| Address1: | 750 E ADAMS ST | ||||||||
| Address2: | |||||||||
| City: | SYRACUSE | ||||||||
| State: | NY | ||||||||
| PostalCode: | 132101834 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 3154645540 | ||||||||
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| Other Information | |||||||||
| ProviderEnumerationDate: | 09/25/2020 | ||||||||
| LastUpdateDate: | 09/25/2020 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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| NPICertificationDate: | 09/25/2020 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 363LF0000X | F346438 | NY | Y | Physician Assistants & Advanced Practice Nursing Providers | Nurse Practitioner | Family |
No ID Information.