Provider Demographics
NPI:1174771208
Name:LAW, CYNTHIA MARIE (ANP, C)
Entity type:Individual
Prefix:MS
First Name:CYNTHIA
Middle Name:MARIE
Last Name:LAW
Suffix:
Gender:F
Credentials:ANP, C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:445 FACTORY ST
Mailing Address - Street 2:
Mailing Address - City:WATERTOWN
Mailing Address - State:NY
Mailing Address - Zip Code:13601-2729
Mailing Address - Country:US
Mailing Address - Phone:315-782-4207
Mailing Address - Fax:315-782-8699
Practice Address - Street 1:7845 ROME WESTERNVILLE RD
Practice Address - Street 2:
Practice Address - City:ROME
Practice Address - State:NY
Practice Address - Zip Code:13440-2202
Practice Address - Country:US
Practice Address - Phone:315-337-2500
Practice Address - Fax:855-667-1414
Is Sole Proprietor?:Yes
Enumeration Date:2008-09-03
Last Update Date:2022-04-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NYF30364-01363LA2200X
NYF3030064-2363LA2200X
NYF303064363LA2200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LA2200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerAdult Health