Provider Demographics
NPI:1861610123
Name:FONTANA, STACY CHRISTINE (MS, FNP)
Entity type:Individual
Prefix:
First Name:STACY
Middle Name:CHRISTINE
Last Name:FONTANA
Suffix:
Gender:F
Credentials:MS, FNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7965 AMOR DR
Mailing Address - Street 2:
Mailing Address - City:CLAY
Mailing Address - State:NY
Mailing Address - Zip Code:13041-8638
Mailing Address - Country:US
Mailing Address - Phone:315-505-6725
Mailing Address - Fax:315-435-2835
Practice Address - Street 1:421 MONTGOMERY ST
Practice Address - Street 2:
Practice Address - City:SYRACUSE
Practice Address - State:NY
Practice Address - Zip Code:13202-2923
Practice Address - Country:US
Practice Address - Phone:315-435-3652
Practice Address - Fax:315-435-2835
Is Sole Proprietor?:No
Enumeration Date:2007-04-23
Last Update Date:2007-08-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NYF334966363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily