MARK A PROFETTO (NPI# 1487852851) is a health care provider registered in Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES).
| Nation Provider ID (NPI) | 1487852851 |
| Entity Type | Individual |
| Full Name | MARK A PROFETTO |
| Credential | FNP |
| Practice Address |
4103 Medical Center Dr Fayetteville NY 13066-6600 |
| Practice Telephone | 3156377800 |
| Practice Fax Number | 3156377808 |
| Mailing Telephone | 3156377800 |
| Mailing Fax Number | 3156377808 |
| Enumeration Date | 2007-07-06 |
| Last Update Date | 2011-12-02 |
| Gender Code | M |
| Is Sole Proprietor | N |
| Primary | Taxonomy Code | Classification | License Number | License State | Taxonomy Group |
|---|---|---|---|---|---|
| Y | 363LF0000X |
Nurse Practitioner Specialization: Family |
33 335305 | NY | Physician Assistants & Advanced Practice Nursing Providers |
| Street Address |
4103 MEDICAL CENTER DR |
| City | FAYETTEVILLE |
| State | NY |
| Zip Code | 13066-6600 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1396748414 | Andrew L Finley | Emergency Medicine | 4103 Medical Center Dr, Fayetteville, NY 13066-6600 | 2005-05-23 |
| 1689191736 | Emily M Marris | Physician Assistant | 4103 Medical Center Dr, Fayetteville, NY 13066-6600 | 2017-08-29 |
| 1225397805 | Sarah Kathryn Leo | Registered Nurse | 4103 Medical Center Dr, Fayetteville, NY 13066-6600 | 2012-05-16 |
| 1902134216 | Hannah Lovallo | Physician Assistant | 4103 Medical Center Dr, Fayetteville, NY 13066-6600 | 2009-11-24 |
| 1386811545 | Renee Anne Ryan | Emergency Medicine | 4103 Medical Center Dr, Fayetteville, NY 13066-6600 | 2008-05-15 |
| 1790819126 | Anita D O'malley | Physician Assistant | 4103 Medical Center Dr, Fayetteville, NY 13066-6600 | 2007-03-15 |
| 1144367749 | Nerissa Ann Jackson | Physician Assistant | 4103 Medical Center Dr, Fayetteville, NY 13066-6600 | 2007-01-31 |
| 1841206356 | Linda M Goff | Nurse Practitioner | 4103 Medical Center Dr, Fayetteville, NY 13066-6600 | 2006-08-01 |
| 1215990536 | Stephen J Jackowski | Physician Assistant | 4103 Medical Center Dr, Fayetteville, NY 13066-6600 | 2006-04-08 |
| 1740283829 | Audrey A Mathis | Registered Nurse | 4103 Medical Center Dr, Fayetteville, NY 13066-6600 | 2005-05-23 |
| Find all providers in the same location | ||||
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1457819963 | Word Wellness Center, LLC | Psychologist | 6836 E Genesee Street, Suite A, Fayetteville, NY 13066 | 2019-03-05 |
| 1629529060 | Lorna Boyer Chase | Marriage & Family Therapist | 109 White Heron Circle, Fayetteville, NY 13066 | 2016-10-20 |
| 1699221432 | Roman Batyuk | Nurse Practitioner | 4100 Medical Center Drive, Fayetteville, NY 13066 | 2016-08-31 |
| 1427405133 | National Eye Care, Inc | Optometrist | 5160 Kinloch Circle, Fayetteville, NY 13066 | 2016-05-23 |
| 1013375328 | Kristin Kukenberger | Chiropractor | 7000 E Genesee St Bldg B, Fayetteville, NY 13066 | 2016-02-01 |
| 1124394671 | Susan Hartman Brenizer | Marriage & Family Therapist | 7000 E Genesee St Lyndon Office Park, Bldg. A, Second Floor (upper Level), Fayetteville, NY 13066 | 2012-03-29 |
| 1245541432 | Rene L Converse | Occupational Therapist | 7200 E. Genesee Street, Fayetteville, NY 13066 | 2010-06-23 |
| 1689815805 | Menorah Park Group Residents | Clinic/Center | 12 Jamar Drive, Dewitt, NY 13066 | 2009-03-18 |
| 1063677458 | John Marcena Glezen | Obstetrics & Gynecology | 1 The Gazebo, Fayetteville, NY 13066 | 2008-07-24 |
| 1629232418 | Tucker Martin Harris | Otolaryngology | 4000 Medical Center Dr # 117, Fayetteville, NY 13066 | 2008-07-11 |
| Find all providers in zip 13066 | ||||
| Taxonomy Code | 363LF0000X |
| Grouping | Physician Assistants & Advanced Practice Nursing Providers |
| Classification | Nurse Practitioner |
| Specialization | Family |
| Definition to come... |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1528674181 | Maggie Mullican | Nurse Practitioner | 7084 S Pleasant Ridge Dr, Fayetteville, AR 72704-5447 | 2020-09-18 |
| 1720690167 | Stephen Arthur Lepak | Nurse Practitioner | 6871 Appleton Dr, Fayetteville, PA 17222-9383 | 2020-08-18 |
| 1750990255 | Towauna Daya | Nurse Practitioner | 1338 Redwine Rd, Fayetteville, GA 30215-2509 | 2020-07-30 |
| 1316555642 | Constance Ofundem Takang | Nurse Practitioner | 110 Emerald Lake Ct, Fayetteville, GA 30215-7747 | 2020-07-22 |
| 1851916472 | Breanna Mills | Nurse Practitioner | 2623 N Fire Fly Catch Dr, Fayetteville, AR 72704-6313 | 2020-06-09 |
| 1922621069 | Laura Sarai Perez | Nurse Practitioner | 480 Lees Lake Rd, Fayetteville, GA 30214-3106 | 2020-05-23 |
| 1902431125 | Crystal Baker English | Nurse Practitioner | 113 Old Bethel Rd, Fayetteville, TN 37334-6186 | 2020-03-09 |
| 1568092708 | Stephanie Elizabeth Fields | Nurse Practitioner | 1265 Highway 54 Ste 402, Fayetteville, GA 30214-4537 | 2020-01-15 |
| 1437616364 | Andrea Teal Bergman | Nurse Practitioner | Physicians Medical Walk In Care, 2893 Huntsville Hwy, Fayetteville, TN 37334-6729 | 2019-02-27 |
| 1639634447 | Arica Adams-gro'ce | Nurse Practitioner | 4028 Lifestyle Rd, Fayetteville, NC 28312-9335 | 2019-02-06 |
| Find all providers in FAYETTEVILLE | ||||
| City | FAYETTEVILLE |
| Zip Code | 13066 |
Please comment or provide details below to improve the information on MARK A PROFETTO.
| Data Provider | Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES) |
| Jurisdiction | Medicare & Medicaid |
This dataset includes 5.44 million covered health care providers and all health plans and health care clearinghouses, registered with CMA NPPES. Each provider is registered with National Provider Identifier (NPI), full name, status, address, taxonomy, other identifiers, etc.