Provider Demographics
NPI:1003273673
Name:CEDERLUND, LISA DAWN (RN)
Entity Type:Individual
Prefix:
First Name:LISA
Middle Name:DAWN
Last Name:CEDERLUND
Suffix:
Gender:F
Credentials:RN
Other - Prefix:
Other - First Name:LISA
Other - Middle Name:DAWN
Other - Last Name:SAUER
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:RN
Mailing Address - Street 1:PO BOX 506
Mailing Address - Street 2:
Mailing Address - City:PINE BUSH
Mailing Address - State:NY
Mailing Address - Zip Code:12566-0506
Mailing Address - Country:US
Mailing Address - Phone:845-741-3918
Mailing Address - Fax:
Practice Address - Street 1:112 RED BARN RD
Practice Address - Street 2:
Practice Address - City:PINE BUSH
Practice Address - State:NY
Practice Address - Zip Code:12566-7456
Practice Address - Country:US
Practice Address - Phone:845-741-3918
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2016-01-27
Last Update Date:2016-01-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY678468163W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163W00000XNursing Service ProvidersRegistered Nurse