Healthcare Provider Details

I. General information

NPI: 1619578366
Provider Name (Legal Business Name): JECINTER LILIAN ADHIAMBO OTIENO NURSE PRACTITIONER
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 11/07/2020
Last Update Date: 08/05/2025
Certification Date: 08/05/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

16 CRAWFORD ST
CORTLAND NY
13045-3200
US

IV. Provider business mailing address

238 ORISKANY BLVD
WHITESBORO NY
13492-1540
US

V. Phone/Fax

Practice location:
  • Phone: 315-363-9281
  • Fax: 315-363-9286
Mailing address:
  • Phone: 315-768-7181
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LP0808X
TaxonomyPsychiatric/Mental Health Nurse Practitioner
License NumberF403123
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: