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General NPI Number Information
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NPI Number | 1932112778
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Entity Type | Individual
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Provider Name | LISA A. CICO NP
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Gender | Female
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Dates
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Enumeration Date | 08/14/2006
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Last Update Date | 04/22/2013
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Provider Practice Location Address
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Address Line | 90 PRESIDENTIAL PLZ 1ST FLOOR
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City | SYRACUSE
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State | NY
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Zip | 13202-2240
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Country | US
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Telephone | 315-464-8224
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Fax | 315-464-2187
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Provider Business Mailing Address
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Address Line | 750 E ADAMS ST DEPARTMENT OF SURGERY
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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 | 315-464-6278
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Fax | 315-464-6365
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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 | 163W00000X
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Taxonomy Name | Registered Nurse
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License Number | 375214
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License Number State | NY
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Taxonomy #2
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Taxonomy Code | 363LA2200X
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Taxonomy Name | Adult Health Nurse Practitioner
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License Number | 302361
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License Number State | NY
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