Provider Demographics
NPI:1467788794
Name:BRATEK, LAN (FNP)
Entity type:Individual
Prefix:
First Name:LAN
Middle Name:
Last Name:BRATEK
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 1:12 LIBERTY ST
Mailing Address - Street 2:
Mailing Address - City:CAZENOVIA
Mailing Address - State:NY
Mailing Address - Zip Code:13035-1008
Mailing Address - Country:US
Mailing Address - Phone:315-404-3095
Mailing Address - Fax:
Practice Address - Street 1:2031 DREAM CATCHER PLZ
Practice Address - Street 2:
Practice Address - City:ONEIDA
Practice Address - State:NY
Practice Address - Zip Code:13421-2729
Practice Address - Country:US
Practice Address - Phone:315-231-5400
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2009-10-21
Last Update Date:2024-06-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NYF354264-01207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine