Provider Demographics
NPI:1194988758
Name:SALMONSEN, TERRY C (NP)
Entity type:Individual
Prefix:
First Name:TERRY
Middle Name:C
Last Name:SALMONSEN
Suffix:
Gender:M
Credentials:NP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:239 ONEIDA ST
Mailing Address - Street 2:
Mailing Address - City:FULTON
Mailing Address - State:NY
Mailing Address - Zip Code:13069-1228
Mailing Address - Country:US
Mailing Address - Phone:315-598-4715
Mailing Address - Fax:315-598-4733
Practice Address - Street 1:10 GEORGE ST
Practice Address - Street 2:
Practice Address - City:OSWEGO
Practice Address - State:NY
Practice Address - Zip Code:13126-3276
Practice Address - Country:US
Practice Address - Phone:315-598-4790
Practice Address - Fax:315-343-4663
Is Sole Proprietor?:No
Enumeration Date:2008-07-03
Last Update Date:2011-12-05
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
NYF335611363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY02997217Medicaid
NY02997217Medicaid