Basic Information
| Provider Information | |||||||||
| NPI: | 1356501548 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | NORSKY | ||||||||
| FirstName: | THERESA | ||||||||
| MiddleName: | CECELIA | ||||||||
| NamePrefix: | MRS. | ||||||||
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| Credential: | MSN,ANP, FNP-C | ||||||||
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| Mailing Information | |||||||||
| Address1: | 722 W WATER ST | ||||||||
| Address2: | |||||||||
| City: | ELMIRA | ||||||||
| State: | NY | ||||||||
| PostalCode: | 149052435 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 6072712050 | ||||||||
| FaxNumber: | 6072712099 | ||||||||
| Practice Location | |||||||||
| Address1: | 418 S HAMILTON ST | ||||||||
| Address2: | |||||||||
| City: | PAINTED POST | ||||||||
| State: | NY | ||||||||
| PostalCode: | 148709705 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 6079362089 | ||||||||
| FaxNumber: | 6079368176 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 06/11/2008 | ||||||||
| LastUpdateDate: | 11/14/2015 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | Y | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 363LA2200X | F301202 | NY | N | Physician Assistants & Advanced Practice Nursing Providers | Nurse Practitioner | Adult Health | 363L00000X | F333318 | NY | Y | Physician Assistants & Advanced Practice Nursing Providers | Nurse Practitioner |
ID Information
| ID | Type | State | Issuer | Description | 02471667 | 05 | NY | MEDICAID |