Provider Demographics
NPI:1841608825
Name:GNADT, MARION (FNP-C)
Entity Type:Individual
Prefix:
First Name:MARION
Middle Name:
Last Name:GNADT
Suffix:
Gender:F
Credentials:FNP-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:200 FRONT ST
Mailing Address - Street 2:STE C
Mailing Address - City:VESTAL
Mailing Address - State:NY
Mailing Address - Zip Code:13850-1559
Mailing Address - Country:US
Mailing Address - Phone:607-239-5694
Mailing Address - Fax:607-239-5720
Practice Address - Street 1:200 FRONT ST
Practice Address - Street 2:STE C
Practice Address - City:VESTAL
Practice Address - State:NY
Practice Address - Zip Code:13850-1559
Practice Address - Country:US
Practice Address - Phone:607-239-5694
Practice Address - Fax:607-239-5720
Is Sole Proprietor?:Yes
Enumeration Date:2014-07-23
Last Update Date:2017-03-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NYF338776-1363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
Provider Identifiers
StateIdentifier IDID TypeIssuer
J400353319Medicare PIN