Provider Demographics
NPI:1700077393
Name:FONS, ANN M (FNP)
Entity Type:Individual
Prefix:MS
First Name:ANN
Middle Name:M
Last Name:FONS
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 1:22571 SUMMIT DR
Mailing Address - Street 2:
Mailing Address - City:WATERTOWN
Mailing Address - State:NY
Mailing Address - Zip Code:13601-7233
Mailing Address - Country:US
Mailing Address - Phone:315-782-0136
Mailing Address - Fax:
Practice Address - Street 1:22571 SUMMIT DR
Practice Address - Street 2:
Practice Address - City:WATERTOWN
Practice Address - State:NY
Practice Address - Zip Code:13601-7233
Practice Address - Country:US
Practice Address - Phone:315-782-0136
Practice Address - Fax:315-782-7212
Is Sole Proprietor?:No
Enumeration Date:2007-08-07
Last Update Date:2014-06-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY335331363LF0000X
NYF3353311363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY02960263Medicaid
NY02960263Medicaid