Provider Demographics
NPI:1306184403
Name:ARNOLD, ADRIANE NICOLE (PA-C)
Entity Type:Individual
Prefix:MRS
First Name:ADRIANE
Middle Name:NICOLE
Last Name:ARNOLD
Suffix:
Gender:F
Credentials:PA-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:317 S CLINTON ST
Mailing Address - Street 2:APT 4D
Mailing Address - City:SYRACUSE
Mailing Address - State:NY
Mailing Address - Zip Code:13202-1216
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:317 S CLINTON ST
Practice Address - Street 2:APT 4D
Practice Address - City:SYRACUSE
Practice Address - State:NY
Practice Address - Zip Code:13202-1216
Practice Address - Country:US
Practice Address - Phone:972-489-7758
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2013-01-23
Last Update Date:2013-07-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAPA22769363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant