Provider Demographics
NPI:1275549966
Name:AGUIRRE, ANNE M (NP)
Entity Type:Individual
Prefix:
First Name:ANNE
Middle Name:M
Last Name:AGUIRRE
Suffix:
Gender:F
Credentials:NP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 91
Mailing Address - Street 2:
Mailing Address - City:WATERTOWN
Mailing Address - State:NY
Mailing Address - Zip Code:13601-0091
Mailing Address - Country:US
Mailing Address - Phone:315-782-4207
Mailing Address - Fax:315-782-8699
Practice Address - Street 1:5989 BIG TREE RD
Practice Address - Street 2:SUITE A
Practice Address - City:LAKEVILLE
Practice Address - State:NY
Practice Address - Zip Code:14480-9719
Practice Address - Country:US
Practice Address - Phone:585-346-4462
Practice Address - Fax:585-346-4463
Is Sole Proprietor?:No
Enumeration Date:2006-08-01
Last Update Date:2016-04-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NYF333226363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner
Provider Identifiers
StateIdentifier IDID TypeIssuer
P33007Medicare UPIN
NYRA0254Medicare PIN