Provider Demographics
NPI:1043281546
Name:WHITE, TERRY LEE (RN FNP)
Entity Type:Individual
Prefix:MS
First Name:TERRY
Middle Name:LEE
Last Name:WHITE
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Gender:F
Credentials:RN FNP
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Mailing Address - Street 1:1001 W FAYETTE ST
Mailing Address - Street 2:SUITE 400
Mailing Address - City:SYRACUSE
Mailing Address - State:NY
Mailing Address - Zip Code:13204-2859
Mailing Address - Country:US
Mailing Address - Phone:315-472-1488
Mailing Address - Fax:315-472-8060
Practice Address - Street 1:4900 BROAD RD
Practice Address - Street 2:SUITE 4K
Practice Address - City:SYRACUSE
Practice Address - State:NY
Practice Address - Zip Code:13215-2265
Practice Address - Country:US
Practice Address - Phone:315-492-5784
Practice Address - Fax:315-492-5183
Is Sole Proprietor?:No
Enumeration Date:2006-02-01
Last Update Date:2008-05-06
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Provider Licenses
StateLicense IDTaxonomies
NY332034363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
Provider Identifiers
StateIdentifier IDID TypeIssuer
NYRB1187Medicare PIN
NYP00358412Medicare PIN