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NPI Code Detail

MEDICARE: LISA A OLSON-GUGERTY NP

MEDICARE:   LISA A OLSON-GUGERTY  NP
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
1363LF0000XFamily Nurse PractitionerF336857NY

Other Identifiers

# Provider Identifier Provider Identifier Type Provider Identifier State Provider Identifier Issuer
1MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number : 1083902027
Entity Type Code : Individual
Provider Name (Legal Business Name) : LISA A OLSON-GUGERTY NP
Provider Business Mailing Address
First Line : 82 COPELAND AVE
Second Line :
City : HOMER
State : NY
Zip : 13077-1528
Country : US
Telephone Number : 607-749-2640
Fax Number : 607-749-2644
Provider Business Practice Location Address
First Line : 82 COPELAND AVE
Second Line :
City : HOMER
State : NY
Zip : 13077-1528
Country : US
Telephone Number : 607-749-2640
Fax Number : 607-749-2644
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 07/12/2011
Last Update Date : 08/23/2013

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Directions to “ LISA A OLSON-GUGERTY NP” Practice Location

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