Provider Demographics
NPI:1619392818
Name:LUGO, CYNTHIA L (REGISTERED NURSE)
Entity Type:Individual
Prefix:
First Name:CYNTHIA
Middle Name:L
Last Name:LUGO
Suffix:
Gender:F
Credentials:REGISTERED NURSE
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:315 RICHFIELD AVE
Mailing Address - Street 2:
Mailing Address - City:SYRACUSE
Mailing Address - State:NY
Mailing Address - Zip Code:13205-3121
Mailing Address - Country:US
Mailing Address - Phone:315-317-5463
Mailing Address - Fax:
Practice Address - Street 1:315 RICHFIELD AVE
Practice Address - Street 2:
Practice Address - City:SYRACUSE
Practice Address - State:NY
Practice Address - Zip Code:13205-3121
Practice Address - Country:US
Practice Address - Phone:315-317-5463
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2014-02-25
Last Update Date:2014-02-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY635802-1163W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163W00000XNursing Service ProvidersRegistered Nurse