Provider Demographics
NPI:1235201575
Name:LASSE, MARY ELIZABETH (FNP)
Entity Type:Individual
Prefix:MS
First Name:MARY
Middle Name:ELIZABETH
Last Name:LASSE
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 1:1 HATFIELD LN
Mailing Address - Street 2:
Mailing Address - City:GOSHEN
Mailing Address - State:NY
Mailing Address - Zip Code:10924-6752
Mailing Address - Country:US
Mailing Address - Phone:845-360-5530
Mailing Address - Fax:845-360-5526
Practice Address - Street 1:1 HATFIELD LN
Practice Address - Street 2:
Practice Address - City:GOSHEN
Practice Address - State:NY
Practice Address - Zip Code:10924-6752
Practice Address - Country:US
Practice Address - Phone:845-360-5530
Practice Address - Fax:845-360-5526
Is Sole Proprietor?:No
Enumeration Date:2006-11-14
Last Update Date:2010-10-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY336122363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily