Provider Demographics
NPI:1114285426
Name:WU, LINA (FNP)
Entity Type:Individual
Prefix:
First Name:LINA
Middle Name:
Last Name:WU
Suffix:
Gender:F
Credentials:FNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:69 W UTICA ST
Mailing Address - Street 2:APT 3
Mailing Address - City:OSWEGO
Mailing Address - State:NY
Mailing Address - Zip Code:13126-3085
Mailing Address - Country:US
Mailing Address - Phone:607-321-4577
Mailing Address - Fax:
Practice Address - Street 1:69 W UTICA ST
Practice Address - Street 2:APT 3
Practice Address - City:OSWEGO
Practice Address - State:NY
Practice Address - Zip Code:13126-3085
Practice Address - Country:US
Practice Address - Phone:607-321-4577
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2012-04-25
Last Update Date:2012-04-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY600318163W00000X
NYF337191363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
No163W00000XNursing Service ProvidersRegistered Nurse