Provider Demographics
NPI:1841285731
Name:NEVILLS, KAREN C (NP)
Entity type:Individual
Prefix:
First Name:KAREN
Middle Name:C
Last Name:NEVILLS
Suffix:
Gender:F
Credentials:NP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 2002
Mailing Address - Street 2:
Mailing Address - City:EAST SYRACUSE
Mailing Address - State:NY
Mailing Address - Zip Code:13057-4502
Mailing Address - Country:US
Mailing Address - Phone:315-449-2208
Mailing Address - Fax:315-445-2936
Practice Address - Street 1:531 WASHINGTON ST
Practice Address - Street 2:
Practice Address - City:WATERTOWN
Practice Address - State:NY
Practice Address - Zip Code:13601-4084
Practice Address - Country:US
Practice Address - Phone:315-788-7990
Practice Address - Fax:315-788-4248
Is Sole Proprietor?:Not Answered
Enumeration Date:2005-09-16
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NYF332706363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
Provider Identifiers
StateIdentifier IDID TypeIssuer
S90311Medicare UPIN