Provider Demographics
NPI:1558582411
Name:NANS, ANNE JEANNETTE (RN, PNP, FPMHNP)
Entity Type:Individual
Prefix:MRS
First Name:ANNE
Middle Name:JEANNETTE
Last Name:NANS
Suffix:
Gender:F
Credentials:RN, PNP, FPMHNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:215 WASHINGTON ST STE 221
Mailing Address - Street 2:
Mailing Address - City:WATERTOWN
Mailing Address - State:NY
Mailing Address - Zip Code:13601-3333
Mailing Address - Country:US
Mailing Address - Phone:315-788-0105
Mailing Address - Fax:315-788-0939
Practice Address - Street 1:215 WASHINGTON ST STE 221
Practice Address - Street 2:
Practice Address - City:WATERTOWN
Practice Address - State:NY
Practice Address - Zip Code:13601-3333
Practice Address - Country:US
Practice Address - Phone:315-788-0105
Practice Address - Fax:315-788-0939
Is Sole Proprietor?:Yes
Enumeration Date:2007-05-01
Last Update Date:2016-10-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY544753-1363LP0200X
NY401614363LP0808X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP0808XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPsychiatric/Mental Health
No363LP0200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPediatrics