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NPI Code Detail

MEDICARE: MRS. GRACIA LYNNETTE ROULAN MSN, FNP

MEDICARE: MRS. GRACIA LYNNETTE ROULAN MSN, FNP
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
1363LF0000XFamily Nurse Practitioner337452NY

General Provider Information

NPI Number : 1285989681
Entity Type Code : Individual
Provider Name (Legal Business Name) : MRS. GRACIA LYNNETTE ROULAN MSN, FNP
Provider Business Mailing Address
First Line : 1050 W GENESEE ST
Second Line :
City : SYRACUSE
State : NY
Zip : 13204-2243
Country : US
Telephone Number : 315-477-4663
Fax Number :
Provider Business Practice Location Address
First Line : 1050 W GENESEE ST
Second Line :
City : SYRACUSE
State : NY
Zip : 13204-2243
Country : US
Telephone Number : 315-641-2385
Fax Number : 315-305-4677
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 07/23/2012
Last Update Date : 09/25/2025

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