Provider Demographics
NPI:1508954488
Name:VONHASSEL, THERESA (APRN, NP)
Entity Type:Individual
Prefix:
First Name:THERESA
Middle Name:
Last Name:VONHASSEL
Suffix:
Gender:F
Credentials:APRN, NP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:373 SAWYER HOLLOW RD
Mailing Address - Street 2:
Mailing Address - City:SUMMIT
Mailing Address - State:NY
Mailing Address - Zip Code:12175-1922
Mailing Address - Country:US
Mailing Address - Phone:518-287-1147
Mailing Address - Fax:518-287-1147
Practice Address - Street 1:189 MAIN ST
Practice Address - Street 2:SUITE 203
Practice Address - City:ONEONTA
Practice Address - State:NY
Practice Address - Zip Code:13820-3510
Practice Address - Country:US
Practice Address - Phone:607-436-9030
Practice Address - Fax:607-436-9031
Is Sole Proprietor?:Yes
Enumeration Date:2006-10-10
Last Update Date:2023-10-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY400713363LP0808X
NY331368363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
No363LP0808XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPsychiatric/Mental Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY7339740OtherGHI
NY475672OtherVALUE OPTIONS
NY02369446Medicaid
NYME987450OtherMVP
NYDD6220Medicare ID - Type UnspecifiedBINGHAMTON
NY02369446Medicaid
NYS35146Medicare UPIN