Basic Information
| Provider Information | |||||||||
| NPI: | 1215481049 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | GIFFIN | ||||||||
| FirstName: | MONA | ||||||||
| MiddleName: | |||||||||
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| Credential: | NP | ||||||||
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| OtherLastName: | HANCE | ||||||||
| OtherFirstName: | MONA | ||||||||
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| OtherLastNameType: | 1 | ||||||||
| Mailing Information | |||||||||
| Address1: | 50 LEROY ST | ||||||||
| Address2: | |||||||||
| City: | POTSDAM | ||||||||
| State: | NY | ||||||||
| PostalCode: | 136761786 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 3152653300 | ||||||||
| FaxNumber: | 3152616025 | ||||||||
| Practice Location | |||||||||
| Address1: | 80 E MAIN ST | ||||||||
| Address2: | AFTER HOURS | ||||||||
| City: | CANTON | ||||||||
| State: | NY | ||||||||
| PostalCode: | 136171450 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 3153863300 | ||||||||
| FaxNumber: | 3152616330 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 08/10/2016 | ||||||||
| LastUpdateDate: | 08/10/2016 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | Y | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 363LF0000X | 340821 | NY | Y | 193200000X MULTI-SPECIALTY GROUP | Physician Assistants & Advanced Practice Nursing Providers | Nurse Practitioner | Family |
No ID Information.