Provider Demographics
NPI:1689776023
Name:LAWSING, LISA M (FNP)
Entity Type:Individual
Prefix:
First Name:LISA
Middle Name:M
Last Name:LAWSING
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 1:1129 COMMONS AVE
Mailing Address - Street 2:
Mailing Address - City:CORTLAND
Mailing Address - State:NY
Mailing Address - Zip Code:13045-1651
Mailing Address - Country:US
Mailing Address - Phone:607-756-7200
Mailing Address - Fax:
Practice Address - Street 1:1129 COMMONS AVE
Practice Address - Street 2:
Practice Address - City:CORTLAND
Practice Address - State:NY
Practice Address - Zip Code:13045-1651
Practice Address - Country:US
Practice Address - Phone:607-756-7200
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-09-05
Last Update Date:2011-03-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY336302207P00000X
NYF336302-1363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
No207P00000XAllopathic & Osteopathic PhysiciansEmergency Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
MENP425602OtherMED B - 200051
ME102380203OtherMEDICAID - CCHS OFC
ME203979OtherMEDICARE A - CCHS
ME432609399OtherMEDICAID - PERS
ME102380302OtherMEDICAID - CCHS HOSP
MEMM7480OtherMEDICARE - GROUP
MENP425601OtherMEDICARE B - FOR MM7480
P96664Medicare ID - Type Unspecified
ME432609399OtherMEDICAID - PERS
MENP425601OtherMEDICARE B - FOR MM7480