Provider Demographics
NPI:1619982436
Name:LUSIGNAN, PAMELA (NP)
Entity Type:Individual
Prefix:
First Name:PAMELA
Middle Name:
Last Name:LUSIGNAN
Suffix:
Gender:F
Credentials:NP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 304
Mailing Address - Street 2:
Mailing Address - City:GLENS FALLS
Mailing Address - State:NY
Mailing Address - Zip Code:12801-0304
Mailing Address - Country:US
Mailing Address - Phone:518-654-6499
Mailing Address - Fax:518-654-7303
Practice Address - Street 1:13 PALMER AVE
Practice Address - Street 2:EVERGREEN HEALTH CENTER
Practice Address - City:CORINTH
Practice Address - State:NY
Practice Address - Zip Code:12822-1145
Practice Address - Country:US
Practice Address - Phone:518-654-6499
Practice Address - Fax:518-654-7303
Is Sole Proprietor?:No
Enumeration Date:2006-07-30
Last Update Date:2012-06-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NYF301311363LA2200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LA2200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerAdult Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY02327728Medicaid
NYJ400008218OtherMEDICARE
NYP00812472OtherRR MEDICARE