Healthcare Provider Details

I. General information

NPI: 1033106018
Provider Name (Legal Business Name): JANET LUCILLE LOTTERMOSER NP
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

Provider Other Name: JANET LUCILLE SWEET ANP

II. Dates (important events)

Enumeration Date: 10/04/2005
Last Update Date: 10/25/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5857 GLENDORA RD
CICERO NY
13039-9571
US

IV. Provider business mailing address

5857 GLENDORA RD
CICERO NY
13039-9571
US

V. Phone/Fax

Practice location:
  • Phone: 315-699-3830
  • Fax: 707-471-3830
Mailing address:
  • Phone: 315-699-3830
  • Fax: 707-471-3830

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363L00000X
TaxonomyNurse Practitioner
License NumberF300105
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: