Healthcare Provider Details

I. General information

NPI: 1750205928
Provider Name (Legal Business Name): LISA PACANA INDEPENDENT SERVICE COORDINATION, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/08/2026
Last Update Date: 08/08/2026
Certification Date: 08/08/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2409 LAKE MEAD RD
NIAGARA FALLS NY
14304-2984
US

IV. Provider business mailing address

PO BOX 244
NIAGARA FALLS NY
14304-0244
US

V. Phone/Fax

Practice location:
  • Phone: 716-909-0416
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code171M00000X
TaxonomyCase Manager/Care Coordinator
License Number
License Number State

VIII. Authorized Official

Name: LISA PACANA
Title or Position: SERVICE COORDINATOR
Credential:
Phone: 716-909-0416