Provider Demographics
NPI:1306510730
Name:MCGOVERN, EMILY EDNA (FNP)
Entity type:Individual
Prefix:
First Name:EMILY
Middle Name:EDNA
Last Name:MCGOVERN
Suffix:
Gender:F
Credentials:FNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:19472 US ROUTE 11 STE N101
Mailing Address - Street 2:
Mailing Address - City:WATERTOWN
Mailing Address - State:NY
Mailing Address - Zip Code:13601-6897
Mailing Address - Country:US
Mailing Address - Phone:315-786-1924
Mailing Address - Fax:315-786-0823
Practice Address - Street 1:19472 US ROUTE 11 STE N101
Practice Address - Street 2:
Practice Address - City:WATERTOWN
Practice Address - State:NY
Practice Address - Zip Code:13601-6897
Practice Address - Country:US
Practice Address - Phone:315-786-1924
Practice Address - Fax:315-786-0823
Is Sole Proprietor?:No
Enumeration Date:2021-08-09
Last Update Date:2021-08-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NYF-348018207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine