Healthcare Provider Details

I. General information

NPI: 1598850463
Provider Name (Legal Business Name): LISA SITTERLY NP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: LISA BURNS

II. Dates (important events)

Enumeration Date: 10/04/2006
Last Update Date: 08/21/2023
Certification Date: 08/21/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1424 GENESEE ST
UTICA NY
13502-5101
US

IV. Provider business mailing address

1040 STATE ST ATTEN: HUMAN RESOURCES
SCHENECTADY NY
12307-1508
US

V. Phone/Fax

Practice location:
  • Phone: 518-374-5353
  • Fax: 518-377-2517
Mailing address:
  • Phone: 518-374-5353
  • Fax: 518-377-2517

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code163W00000X
TaxonomyRegistered Nurse
License Number423653-1
License Number StateNY
# 2
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License NumberF334942-1
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: