Provider Demographics
NPI:1053463265
Name:HART, M RACHEL (RN CA NP)
Entity Type:Individual
Prefix:
First Name:M
Middle Name:RACHEL
Last Name:HART
Suffix:
Gender:F
Credentials:RN CA NP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:824 FRANKLIN PARK DR
Mailing Address - Street 2:
Mailing Address - City:EAST SYRACUSE
Mailing Address - State:NY
Mailing Address - Zip Code:13057-1614
Mailing Address - Country:US
Mailing Address - Phone:315-432-1048
Mailing Address - Fax:
Practice Address - Street 1:824 FRANKLIN PARK DR
Practice Address - Street 2:
Practice Address - City:EAST SYRACUSE
Practice Address - State:NY
Practice Address - Zip Code:13057-1614
Practice Address - Country:US
Practice Address - Phone:315-432-1048
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-01-17
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NYF3000181363LA2200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LA2200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerAdult Health