Basic Information
Provider Information | |||||||||
NPI: | 1689776023 | ||||||||
EntityType: | 1 | ||||||||
ReplacementNPI: |   | ||||||||
OrganizationName: |   | ||||||||
LastName: | LAWSING | ||||||||
FirstName: | LISA | ||||||||
MiddleName: | M | ||||||||
NamePrefix: |   | ||||||||
NameSuffix: |   | ||||||||
Credential: | FNP | ||||||||
OtherOrganizationName: |   | ||||||||
OtherOrganizationType: |   | ||||||||
OtherLastName: |   | ||||||||
OtherFirstName: |   | ||||||||
OtherMiddleName: |   | ||||||||
OtherNamePrefix: |   | ||||||||
OtherNameSuffix: |   | ||||||||
OtherCredential: |   | ||||||||
OtherLastNameType: |   | ||||||||
Mailing Information | |||||||||
Address1: | 1129 COMMONS AVE | ||||||||
Address2: |   | ||||||||
City: | CORTLAND | ||||||||
State: | NY | ||||||||
PostalCode: | 130451651 | ||||||||
CountryCode: | US | ||||||||
TelephoneNumber: | 6077567200 | ||||||||
FaxNumber: |   | ||||||||
Practice Location | |||||||||
Address1: | 1129 COMMONS AVE | ||||||||
Address2: |   | ||||||||
City: | CORTLAND | ||||||||
State: | NY | ||||||||
PostalCode: | 130451651 | ||||||||
CountryCode: | US | ||||||||
TelephoneNumber: | 6077567200 | ||||||||
FaxNumber: |   | ||||||||
Other Information | |||||||||
ProviderEnumerationDate: | 09/05/2006 | ||||||||
LastUpdateDate: | 03/31/2011 | ||||||||
NPIDeactivationReasonCode: |   | ||||||||
NPIDeactivationDate: |   | ||||||||
NPIReactivationDate: |   | ||||||||
ProviderGenderCode: | F | ||||||||
AuthorizedOfficialLastName: |   | ||||||||
AuthorizedOfficialFirstName: |   | ||||||||
AuthorizedOfficialMiddleName: |   | ||||||||
AuthorizedOfficialTitleorPosition: |   | ||||||||
AuthorizedOfficialTelephone: |   | ||||||||
IsSoleProprietor: | N | ||||||||
IsOrganizationSubpart: |   | ||||||||
ParentOrganizationLBN: |   | ||||||||
AuthorizedOfficialNamePrefix: |   | ||||||||
AuthorizedOfficialNameSuffix: |   | ||||||||
AuthorizedOfficialCredential: |   | ||||||||
NPICertificationDate: |   |
Taxonomy Information
Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207P00000X | 336302 | NY | N |   | Allopathic & Osteopathic Physicians | Emergency Medicine |   | 363LF0000X | F336302-1 | NY | Y |   | Physician Assistants & Advanced Practice Nursing Providers | Nurse Practitioner | Family |
ID Information
ID | Type | State | Issuer | Description | NP425602 | 01 | ME | MED B - 200051 | OTHER | 102380203 | 01 | ME | MEDICAID - CCHS OFC | OTHER | 203979 | 01 | ME | MEDICARE A - CCHS | OTHER | 432609399 | 01 | ME | MEDICAID - PERS | OTHER | 102380302 | 01 | ME | MEDICAID - CCHS HOSP | OTHER | MM7480 | 01 | ME | MEDICARE - GROUP | OTHER | NP425601 | 01 | ME | MEDICARE B - FOR MM7480 | OTHER |