Provider Demographics
NPI:1720160112
Name:EGAN, MERRY E (FNP)
Entity Type:Individual
Prefix:MRS
First Name:MERRY
Middle Name:E
Last Name:EGAN
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 1:56 WILDWOOD AVE
Mailing Address - Street 2:
Mailing Address - City:FULTON
Mailing Address - State:NY
Mailing Address - Zip Code:13069-6900
Mailing Address - Country:US
Mailing Address - Phone:315-593-7086
Mailing Address - Fax:
Practice Address - Street 1:RUDOLPH ROAD
Practice Address - Street 2:WALKER HEALTH CTR, SUNY OSWEGO
Practice Address - City:OSWEGO
Practice Address - State:NY
Practice Address - Zip Code:13126
Practice Address - Country:US
Practice Address - Phone:315-312-4100
Practice Address - Fax:315-312-5409
Is Sole Proprietor?:No
Enumeration Date:2006-10-19
Last Update Date:2023-03-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NYF331288363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
Provider Identifiers
StateIdentifier IDID TypeIssuer
NYME0644737OtherDEA NUMBER
NYS35124Medicare UPIN