Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 363LA2200X | Nurse Practitioner - Adult Health | F303462 | NY |
N | 363LP0200X | Nurse Practitioner - Pediatrics | F381665 | NY |
NPI | 1023074069 |
---|---|
Provider Name | Lisa Feitshans |
First Address | Corfu, NY 14036-9753 |
Second Address | Corfu, NY 14036-9753 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 26/04/2006 |
Last Update Date | 08/07/2007 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
02319111 | (05) | NY |
Q36254 | (02) | NY |