Provider Demographics
NPI:1699294082
Name:BLACKMER, SONYA LYNNE (FNP)
Entity type:Individual
Prefix:MRS
First Name:SONYA
Middle Name:LYNNE
Last Name:BLACKMER
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 1:84 LAMPLIGHTER ACRES
Mailing Address - Street 2:
Mailing Address - City:FORT EDWARD
Mailing Address - State:NY
Mailing Address - Zip Code:12828-9317
Mailing Address - Country:US
Mailing Address - Phone:518-480-5870
Mailing Address - Fax:
Practice Address - Street 1:84 LAMPLIGHTER ACRES
Practice Address - Street 2:
Practice Address - City:FORT EDWARD
Practice Address - State:NY
Practice Address - Zip Code:12828-9317
Practice Address - Country:US
Practice Address - Phone:518-480-5870
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2017-09-17
Last Update Date:2022-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY631400163W00000X
NYF341565-1363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
No163W00000XNursing Service ProvidersRegistered Nurse