Provider Demographics
NPI:1538405246
Name:O'CONNOR-RYERSON, NANCY LYNNE (NP)
Entity type:Individual
Prefix:MRS
First Name:NANCY
Middle Name:LYNNE
Last Name:O'CONNOR-RYERSON
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 1:2259 CENTER RD
Mailing Address - Street 2:
Mailing Address - City:SCIPIO CENTER
Mailing Address - State:NY
Mailing Address - Zip Code:13147-4109
Mailing Address - Country:US
Mailing Address - Phone:315-730-7815
Mailing Address - Fax:
Practice Address - Street 1:135 STATE ST
Practice Address - Street 2:
Practice Address - City:AUBURN
Practice Address - State:NY
Practice Address - Zip Code:13024-9001
Practice Address - Country:US
Practice Address - Phone:315-253-8401
Practice Address - Fax:315-255-1371
Is Sole Proprietor?:Yes
Enumeration Date:2012-12-27
Last Update Date:2012-12-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NYF304050-1363LA2200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LA2200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerAdult Health