Provider Demographics
NPI:1376974865
Name:RATHJE, VERA (ANP)
Entity Type:Individual
Prefix:
First Name:VERA
Middle Name:
Last Name:RATHJE
Suffix:
Gender:F
Credentials:ANP
Other - Prefix:
Other - First Name:
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Other - Credentials:
Mailing Address - Street 1:5100 WEST TAFT ROAD
Mailing Address - Street 2:SUITE 2G
Mailing Address - City:LIVERPOOL
Mailing Address - State:NY
Mailing Address - Zip Code:13088
Mailing Address - Country:US
Mailing Address - Phone:315-312-0089
Mailing Address - Fax:315-312-0110
Practice Address - Street 1:105 COUNTY ROUTE 45A
Practice Address - Street 2:SUITE 400
Practice Address - City:OSWEGO
Practice Address - State:NY
Practice Address - Zip Code:13126-6673
Practice Address - Country:US
Practice Address - Phone:315-312-0089
Practice Address - Fax:315-312-0110
Is Sole Proprietor?:No
Enumeration Date:2013-12-09
Last Update Date:2016-02-24
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
NYF306700363LA2200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LA2200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerAdult Health