Provider Demographics
NPI:1679358055
Name:AMES, MARIANA ROSE (FNP)
Entity Type:Individual
Prefix:MISS
First Name:MARIANA
Middle Name:ROSE
Last Name:AMES
Suffix:
Gender:F
Credentials:FNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6620 FLY RD
Mailing Address - Street 2:
Mailing Address - City:EAST SYRACUSE
Mailing Address - State:NY
Mailing Address - Zip Code:13057-9791
Mailing Address - Country:US
Mailing Address - Phone:315-464-4472
Mailing Address - Fax:
Practice Address - Street 1:6620 FLY RD STE 305
Practice Address - Street 2:
Practice Address - City:EAST SYRACUSE
Practice Address - State:NY
Practice Address - Zip Code:13057-4205
Practice Address - Country:US
Practice Address - Phone:315-464-3938
Practice Address - Fax:315-464-5359
Is Sole Proprietor?:No
Enumeration Date:2023-08-25
Last Update Date:2023-08-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NYF352006-01363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner