MEDICARE: LORETTA LYNNE EDINGER NP

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	363LF0000X	Family Nurse Practitioner	336816	NY

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1235425372
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	LORETTA LYNNE EDINGER NP

Provider Business Mailing Address
First Line	:	1001 W FAYETTE ST
Second Line	:	SUITE 400
City	:	SYRACUSE
State	:	NY
Zip	:	13204-2856
Country	:	US
Telephone Number	:	315-472-1488
Fax Number	:

Provider Business Practice Location Address
First Line	:	5-7 STATE STREET
Second Line	:
City	:	TULLY
State	:	NY
Zip	:	13159-3218
Country	:	US
Telephone Number	:	315-696-4635
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	06/28/2011
Last Update Date	:	01/16/2013

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