Provider records sourced from NPPES (CMS National Plan & Provider Enumeration System). Data current as of August 10, 2026.

Mark Theodore, FNP-BC

Individual provider Critical Care Medicine Registered Nurse · NPI 1457793135

Mark Theodore, FNP-BC is a Critical Care Medicine Registered Nurse in Utica, New York. Practices as a sole proprietor. Licensed in New York.

Licensed in
NY
In the registry since
2013
Specialties on file
2
What do these letters mean?
FNP-BC — Family Nurse Practitioner, Board Certified
A family nurse practitioner certified by the ANCC.

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Practice location Address checks out

1656 Champlin Ave
Utica, NY 13502-4830
Phone: (315) 624-6000
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Pin is approximate — placed at the ZIP-code centre, not the exact door.

Specialties & licences

Family Nurse Practitioner (primary) Taxonomy 363LF0000X · Licence 338083 (NY)
Critical Care Medicine Registered Nurse Taxonomy 163WC0200X · Licence 629932 (NY)

Record details

NPI number1457793135
Entity typeIndividual (Type 1)
GenderMale
Credentials FNP-BC
Sole proprietorYes
NPI enumeratedJuly 23, 2013
Last updated in NPPESJuly 23, 2013
Mailing address1656 Champlin Ave, Utica, NY 13502-4830

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