Provider Demographics
NPI:1407283609
Name:PUGH, BRITTANY JADE (PA)
Entity Type:Individual
Prefix:
First Name:BRITTANY
Middle Name:JADE
Last Name:PUGH
Suffix:
Gender:F
Credentials:PA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:357 GENESEE ST
Mailing Address - Street 2:
Mailing Address - City:ONEIDA
Mailing Address - State:NY
Mailing Address - Zip Code:13421-2693
Mailing Address - Country:US
Mailing Address - Phone:315-363-8800
Mailing Address - Fax:315-363-0103
Practice Address - Street 1:357 GENESEE ST
Practice Address - Street 2:
Practice Address - City:ONEIDA
Practice Address - State:NY
Practice Address - Zip Code:13421-2693
Practice Address - Country:US
Practice Address - Phone:315-363-8800
Practice Address - Fax:315-363-0103
Is Sole Proprietor?:Yes
Enumeration Date:2013-10-02
Last Update Date:2013-10-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY017026-1363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner