Provider Demographics
NPI:1518996321
Name:KAPFER, MARY THERESE (ANP)
Entity Type:Individual
Prefix:
First Name:MARY
Middle Name:THERESE
Last Name:KAPFER
Suffix:
Gender:F
Credentials:ANP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7136 NELSON RD
Mailing Address - Street 2:
Mailing Address - City:CANASTOTA
Mailing Address - State:NY
Mailing Address - Zip Code:13032-4633
Mailing Address - Country:US
Mailing Address - Phone:315-697-7175
Mailing Address - Fax:
Practice Address - Street 1:4939 BRITTONFIELD PKWY
Practice Address - Street 2:BUILDING B SUITE 210
Practice Address - City:EAST SYRACUSE
Practice Address - State:NY
Practice Address - Zip Code:13057-9208
Practice Address - Country:US
Practice Address - Phone:315-471-8404
Practice Address - Fax:315-471-6803
Is Sole Proprietor?:No
Enumeration Date:2006-07-02
Last Update Date:2009-08-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NYF302350-1363LA2200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LA2200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerAdult Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
NYSI021553151Medicaid
NYP00718575Medicare PIN
NYP09858Medicare UPIN
NYCC1095Medicare ID - Type Unspecified
NYSI021553151Medicaid