Provider Demographics
NPI:1407177793
Name:FONSECA, RENEE P (FNP-C)
Entity Type:Individual
Prefix:
First Name:RENEE
Middle Name:P
Last Name:FONSECA
Suffix:
Gender:F
Credentials:FNP-C
Other - Prefix:
Other - First Name:RENEE
Other - Middle Name:P
Other - Last Name:LEONARD
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:4158 S HILL RD
Mailing Address - Street 2:
Mailing Address - City:CAMPBELL
Mailing Address - State:NY
Mailing Address - Zip Code:14821-9753
Mailing Address - Country:US
Mailing Address - Phone:607-368-7063
Mailing Address - Fax:
Practice Address - Street 1:76 VETERAN AVE
Practice Address - Street 2:
Practice Address - City:BATH
Practice Address - State:NY
Practice Address - Zip Code:14810
Practice Address - Country:US
Practice Address - Phone:607-664-4000
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2010-06-21
Last Update Date:2020-03-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY336393363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily