Healthcare Provider Details

I. General information

NPI: 1154550523
Provider Name (Legal Business Name): LISA M KESSEL N.P.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/07/2009
Last Update Date: 07/07/2009
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

77 NELSON ST SUITE 240
AUBURN NY
13021-1944
US

IV. Provider business mailing address

77 NELSON ST SUITE 240
AUBURN NY
13021-1944
US

V. Phone/Fax

Practice location:
  • Phone: 315-252-0810
  • Fax: 315-252-5179
Mailing address:
  • Phone: 315-252-0810
  • Fax: 315-252-5179

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LA2200X
TaxonomyAdult Health Nurse Practitioner
License Number562049-1
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: