MEDICARE: LISA MARIE CANECCHIA ACNP

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	363LA2100X	Acute Care Nurse Practitioner	F430527-1	NY

General Provider Information

NPI Number	:	1639483423
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	LISA MARIE CANECCHIA ACNP

Provider Business Mailing Address
First Line	:	1330 1ST AVE
Second Line	:	APT 629
City	:	NEW YORK
State	:	NY
Zip	:	10021-4742
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	400 E MAIN ST
Second Line	:
City	:	MOUNT KISCO
State	:	NY
Zip	:	10549-3477
Country	:	US
Telephone Number	:	914-666-1042
Fax Number	:

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

Provider Enumeration Date	:	08/04/2010
Last Update Date	:	07/16/2020

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