Provider Demographics
NPI:1124124433
Name:REES, JUDITH MARTGARET (NP)
Entity type:Individual
Prefix:
First Name:JUDITH
Middle Name:MARTGARET
Last Name:REES
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 1:7108 CHASE RD
Mailing Address - Street 2:
Mailing Address - City:FABIUS
Mailing Address - State:NY
Mailing Address - Zip Code:13063-9738
Mailing Address - Country:US
Mailing Address - Phone:315-683-5292
Mailing Address - Fax:
Practice Address - Street 1:725 IRVING AVE
Practice Address - Street 2:SUITE # 304
Practice Address - City:SYRACUSE
Practice Address - State:NY
Practice Address - Zip Code:13210-1603
Practice Address - Country:US
Practice Address - Phone:315-464-5533
Practice Address - Fax:315-464-5579
Is Sole Proprietor?:No
Enumeration Date:2006-09-15
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NYF300866-1363LA2200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LA2200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerAdult Health