Provider Demographics
NPI:1518152917
Name:KINGSBURY, ROSELYNN KNAPP (APRN, BC)
Entity Type:Individual
Prefix:MS
First Name:ROSELYNN
Middle Name:KNAPP
Last Name:KINGSBURY
Suffix:
Gender:F
Credentials:APRN, BC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:555 S STATE ST
Mailing Address - Street 2:
Mailing Address - City:SYRACUSE
Mailing Address - State:NY
Mailing Address - Zip Code:13202-2104
Mailing Address - Country:US
Mailing Address - Phone:315-435-1790
Mailing Address - Fax:315-435-1729
Practice Address - Street 1:555 S STATE ST
Practice Address - Street 2:
Practice Address - City:SYRACUSE
Practice Address - State:NY
Practice Address - Zip Code:13202-2104
Practice Address - Country:US
Practice Address - Phone:315-435-1790
Practice Address - Fax:315-435-1729
Is Sole Proprietor?:No
Enumeration Date:2007-09-09
Last Update Date:2007-09-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NYF333541-1363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily