Provider Demographics
NPI:1407881014
Name:REDMOND, ROWENA ANN (PNP GNP)
Entity Type:Individual
Prefix:MS
First Name:ROWENA
Middle Name:ANN
Last Name:REDMOND
Suffix:
Gender:F
Credentials:PNP GNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:703 EAST MAPLE AVE
Mailing Address - Street 2:TYMESON BUILDING
Mailing Address - City:NEWARK
Mailing Address - State:NY
Mailing Address - Zip Code:14513-9921
Mailing Address - Country:US
Mailing Address - Phone:315-331-1700
Mailing Address - Fax:315-331-3946
Practice Address - Street 1:703 EAST MAPLE AVE
Practice Address - Street 2:TYMESON BUILDING
Practice Address - City:NEWARK
Practice Address - State:NY
Practice Address - Zip Code:14513-9921
Practice Address - Country:US
Practice Address - Phone:315-331-1700
Practice Address - Fax:315-331-3946
Is Sole Proprietor?:No
Enumeration Date:2006-07-11
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NYF340535363LG0600X
NYF380324363LP0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Not Answered363LG0600XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerGerontology
Not Answered363LP0200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPediatrics
Provider Identifiers
StateIdentifier IDID TypeIssuer
RR0R060910Medicare ID - Type Unspecified
S01993Medicare UPIN