Provider Demographics
NPI:1669418190
Name:DONNELLY & OOT FAMILY NURSE PRACTITIONERS
Entity type:Organization
Organization Name:DONNELLY & OOT FAMILY NURSE PRACTITIONERS
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:MARY
Authorized Official - Middle Name:
Authorized Official - Last Name:OOT
Authorized Official - Suffix:
Authorized Official - Credentials:FNP
Authorized Official - Phone:315-656-8999
Mailing Address - Street 1:5900 N BURDICK ST
Mailing Address - Street 2:SUITE 207
Mailing Address - City:EAST SYRACUSE
Mailing Address - State:NY
Mailing Address - Zip Code:13057-9462
Mailing Address - Country:US
Mailing Address - Phone:315-656-8999
Mailing Address - Fax:315-656-8877
Practice Address - Street 1:5900 N BURDICK ST
Practice Address - Street 2:SUITE 207
Practice Address - City:EAST SYRACUSE
Practice Address - State:NY
Practice Address - Zip Code:13057-9462
Practice Address - Country:US
Practice Address - Phone:315-656-8999
Practice Address - Fax:315-656-8877
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-06-22
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamilyGroup - Single Specialty