MEDICARE: CECILIA SEVERINO LAWLOR RN, 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
1	363LA2200X	Adult Health Nurse Practitioner	F301889-1	NY

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	111795CA	OTHER	NY	PREFERRED CARE

General Provider Information

NPI Number	:	1831120294
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	CECILIA SEVERINO LAWLOR RN, NP

Provider Business Mailing Address
First Line	:	125 RED CREEK DR
Second Line	:
City	:	ROCHESTER
State	:	NY
Zip	:	14623-4272
Country	:	US
Telephone Number	:	585-486-0600
Fax Number	:	585-486-0649

Provider Business Practice Location Address
First Line	:	125 RED CREEK DR
Second Line	:
City	:	ROCHESTER
State	:	NY
Zip	:	14623-4272
Country	:	US
Telephone Number	:	585-486-0600
Fax Number	:	585-486-0649

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	07/05/2006
Last Update Date	:	07/08/2007

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