Provider Demographics
NPI:1649800202
Name:GILLETTE, JOANN PAMELA (NP)
Entity type:Individual
Prefix:
First Name:JOANN
Middle Name:PAMELA
Last Name:GILLETTE
Suffix:
Gender:F
Credentials:NP
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Mailing Address - Street 1:612 CORPORATE WAY STE 1M
Mailing Address - Street 2:
Mailing Address - City:VALLEY COTTAGE
Mailing Address - State:NY
Mailing Address - Zip Code:10989-2027
Mailing Address - Country:US
Mailing Address - Phone:844-362-3425
Mailing Address - Fax:718-362-8185
Practice Address - Street 1:918 JAMES ST
Practice Address - Street 2:
Practice Address - City:SYRACUSE
Practice Address - State:NY
Practice Address - Zip Code:13203-2500
Practice Address - Country:US
Practice Address - Phone:844-362-3425
Practice Address - Fax:718-362-8185
Is Sole Proprietor?:No
Enumeration Date:2020-01-23
Last Update Date:2021-12-02
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
NY309518363LP2300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP2300XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPrimary Care