Provider Demographics
NPI:1497407803
Name:LYSIAK, LAUREN (FNP, RN)
Entity Type:Individual
Prefix:
First Name:LAUREN
Middle Name:
Last Name:LYSIAK
Suffix:
Gender:F
Credentials:FNP, RN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2458 INDEPENDENCE AVE
Mailing Address - Street 2:
Mailing Address - City:NIAGARA FALLS
Mailing Address - State:NY
Mailing Address - Zip Code:14301-2438
Mailing Address - Country:US
Mailing Address - Phone:716-243-0639
Mailing Address - Fax:
Practice Address - Street 1:5795 LEWISTON RD
Practice Address - Street 2:
Practice Address - City:NIAGARA UNIVERSITY
Practice Address - State:NY
Practice Address - Zip Code:14109-9809
Practice Address - Country:US
Practice Address - Phone:716-286-8390
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2022-01-26
Last Update Date:2023-10-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY737488-01163WM0705X
NY347952363LA2100X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LA2100XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerAcute Care
No163WM0705XNursing Service ProvidersRegistered NurseMedical-Surgical