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General NPI Number Information
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NPI Number | 1760969653
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Entity Type | Individual
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Provider Name | AISHA LUBEGA NP
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Gender | Female
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Dates
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Enumeration Date | 07/24/2018
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Last Update Date | 07/24/2018
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Provider Practice Location Address
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Address Line | 750 E ADAMS ST
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City | SYRACUSE
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State | NY
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Zip | 13210-2306
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Country | US
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Telephone | 315-464-5540
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Fax |
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Provider Business Mailing Address
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Address Line | 101 BALL RD APT 8
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City | SYRACUSE
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State | NY
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Zip | 13215-1650
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Country | US
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Telephone | 315-289-6626
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 363L00000X
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Taxonomy Name | Nurse Practitioner
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License Number | F343361-1
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License Number State | NY
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