Healthcare Provider Details

I. General information

NPI: 1821217001
Provider Name (Legal Business Name): SUSAN D. LAGASSE RN
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/25/2007
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1519 NYE RD SUITE 110
LYONS NY
14489-9133
US

IV. Provider business mailing address

8729 THOMPSON STATION RD
LYONS NY
14489-9748
US

V. Phone/Fax

Practice location:
  • Phone: 315-946-5722
  • Fax: 315-946-7109
Mailing address:
  • Phone: 315-946-6466
  • Fax: 315-946-7109

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code163WP0808X
TaxonomyPsychiatric/Mental Health Registered Nurse
License Number253835-1
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: