Provider Demographics
NPI:1710175971
Name:CAPUSON, LISSA FRANCES (NP)
Entity Type:Individual
Prefix:MS
First Name:LISSA
Middle Name:FRANCES
Last Name:CAPUSON
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 1:6941 ELAINE DR
Mailing Address - Street 2:SUITE 2
Mailing Address - City:NIAGARA FALLS
Mailing Address - State:NY
Mailing Address - Zip Code:14304-2877
Mailing Address - Country:US
Mailing Address - Phone:716-298-8133
Mailing Address - Fax:
Practice Address - Street 1:6941 ELAINE DR
Practice Address - Street 2:SUITE 2
Practice Address - City:NIAGARA FALLS
Practice Address - State:NY
Practice Address - Zip Code:14304-2877
Practice Address - Country:US
Practice Address - Phone:716-298-8133
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-10-11
Last Update Date:2013-11-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY335370363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily