Provider Demographics
NPI:1629599725
Name:BOVA, LAUREN (NP)
Entity Type:Individual
Prefix:
First Name:LAUREN
Middle Name:
Last Name:BOVA
Suffix:
Gender:F
Credentials:NP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:251 SALINA MEADOWS PKWY STE 100
Mailing Address - Street 2:
Mailing Address - City:SYRACUSE
Mailing Address - State:NY
Mailing Address - Zip Code:13212-4516
Mailing Address - Country:US
Mailing Address - Phone:315-464-2000
Mailing Address - Fax:315-464-2010
Practice Address - Street 1:4900 BROAD ROAD
Practice Address - Street 2:SUITE 4V
Practice Address - City:SYRACUSE
Practice Address - State:NY
Practice Address - Zip Code:13215
Practice Address - Country:US
Practice Address - Phone:315-492-3700
Practice Address - Fax:315-492-3596
Is Sole Proprietor?:No
Enumeration Date:2017-06-29
Last Update Date:2022-07-21
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
NY341816363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner