Basic Information
| Provider Information | |||||||||
| NPI: | 1174995658 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | LYSIUS | ||||||||
| FirstName: | MIDZY | ||||||||
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| Credential: | RN | ||||||||
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| Mailing Information | |||||||||
| Address1: | 5701 E CIRCLE DR | ||||||||
| Address2: | 264 STE 108 | ||||||||
| City: | CICERO | ||||||||
| State: | NY | ||||||||
| PostalCode: | 13039 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 3158765748 | ||||||||
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| Practice Location | |||||||||
| Address1: | 5496 E TAFT RD | ||||||||
| Address2: | |||||||||
| City: | NORTH SYRACUSE | ||||||||
| State: | NY | ||||||||
| PostalCode: | 132123784 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 3155526700 | ||||||||
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| Other Information | |||||||||
| ProviderEnumerationDate: | 10/23/2015 | ||||||||
| LastUpdateDate: | 08/14/2021 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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| NPICertificationDate: | 08/14/2021 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 163W00000X | 685753-1 | NY | N | Nursing Service Providers | Registered Nurse | 363LF0000X | 343225 | NY | Y | Physician Assistants & Advanced Practice Nursing Providers | Nurse Practitioner | Family |
No ID Information.