Provider Demographics
NPI:1740382605
Name:CAREY, ELLEN LYNNE (MS FNP)
Entity Type:Individual
Prefix:MS
First Name:ELLEN
Middle Name:LYNNE
Last Name:CAREY
Suffix:
Gender:F
Credentials:MS FNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5415 W GENESEE ST
Mailing Address - Street 2:SUITE 301
Mailing Address - City:CAMILLUS
Mailing Address - State:NY
Mailing Address - Zip Code:13031-2157
Mailing Address - Country:US
Mailing Address - Phone:315-487-8109
Mailing Address - Fax:315-487-5680
Practice Address - Street 1:5415 W GENESEE ST
Practice Address - Street 2:SUITE 301
Practice Address - City:CAMILLUS
Practice Address - State:NY
Practice Address - Zip Code:13031-2157
Practice Address - Country:US
Practice Address - Phone:315-487-8109
Practice Address - Fax:315-487-5680
Is Sole Proprietor?:No
Enumeration Date:2006-09-02
Last Update Date:2016-04-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY332602363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily