Healthcare Provider Details

I. General information

NPI: 1538282173
Provider Name (Legal Business Name): LEE ELIZABETH QUINLAN WHCNP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/09/2007
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

421 MONTGOMERY ST FL 9
SYRACUSE NY
13202-2923
US

IV. Provider business mailing address

421 MONTGOMERY ST FL 9
SYRACUSE NY
13202-2923
US

V. Phone/Fax

Practice location:
  • Phone: 315-435-3295
  • Fax: 315-435-8242
Mailing address:
  • Phone: 315-435-3295
  • Fax: 315-435-8242

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LW0102X
TaxonomyWomen's Health Nurse Practitioner
License NumberF420193-1
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: