Provider Demographics
NPI:1174684948
Name:SLATER, DOROTHY (PNP)
Entity Type:Individual
Prefix:MS
First Name:DOROTHY
Middle Name:
Last Name:SLATER
Suffix:
Gender:F
Credentials:PNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:405 W HIGH TER
Mailing Address - Street 2:
Mailing Address - City:SYRACUSE
Mailing Address - State:NY
Mailing Address - Zip Code:13219-2434
Mailing Address - Country:US
Mailing Address - Phone:315-488-9746
Mailing Address - Fax:
Practice Address - Street 1:151 INTREPID LN
Practice Address - Street 2:
Practice Address - City:SYRACUSE
Practice Address - State:NY
Practice Address - Zip Code:13205-2552
Practice Address - Country:US
Practice Address - Phone:315-469-8191
Practice Address - Fax:315-469-4482
Is Sole Proprietor?:No
Enumeration Date:2006-12-13
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NYF380913363LP0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP0200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPediatrics