Healthcare Provider Details

I. General information

NPI: 1558113738
Provider Name (Legal Business Name): LORRI LYN LANSING RN
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 04/02/2024
Last Update Date: 04/02/2024
Certification Date: 04/02/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

635 JAMES ST STE 1
SYRACUSE NY
13203-2661
US

IV. Provider business mailing address

107 WOODLAWN TER
SYRACUSE NY
13203-1144
US

V. Phone/Fax

Practice location:
  • Phone: 315-440-6987
  • Fax:
Mailing address:
  • Phone: 315-440-6987
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code163WP0809X
TaxonomyAdult Psychiatric/Mental Health Registered Nurse
License Number640334
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: