Provider Demographics
NPI:1801878640
Name:REISMAN, VANNA A (CNM)
Entity type:Individual
Prefix:
First Name:VANNA
Middle Name:A
Last Name:REISMAN
Suffix:
Gender:F
Credentials:CNM
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:824 FRANKLIN PARK DR.
Mailing Address - Street 2:
Mailing Address - City:EAST SYRACUSE
Mailing Address - State:NY
Mailing Address - Zip Code:13057
Mailing Address - Country:US
Mailing Address - Phone:315-432-1048
Mailing Address - Fax:315-432-9219
Practice Address - Street 1:824 FRANKLIN PARK DR.
Practice Address - Street 2:
Practice Address - City:EAST SYRACUSE
Practice Address - State:NY
Practice Address - Zip Code:13057
Practice Address - Country:US
Practice Address - Phone:315-432-1048
Practice Address - Fax:315-432-9219
Is Sole Proprietor?:No
Enumeration Date:2005-11-17
Last Update Date:2020-03-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NYF0005381176B00000X
NYF360502-1363LX0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LX0001XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerObstetrics & Gynecology
No176B00000XOther Service ProvidersMidwife
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY02185537Medicaid
NYRA5195Medicare ID - Type Unspecified
NY02185537Medicaid