Provider Demographics
NPI:1821217001
Name:LAGASSE, SUSAN D (RN)
Entity Type:Individual
Prefix:MRS
First Name:SUSAN
Middle Name:D
Last Name:LAGASSE
Suffix:
Gender:F
Credentials:RN
Other - Prefix:
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Mailing Address - Street 1:8729 THOMPSON STATION RD
Mailing Address - Street 2:
Mailing Address - City:LYONS
Mailing Address - State:NY
Mailing Address - Zip Code:14489-9748
Mailing Address - Country:US
Mailing Address - Phone:315-946-6466
Mailing Address - Fax:315-946-7109
Practice Address - Street 1:1519 NYE RD
Practice Address - Street 2:SUITE 110
Practice Address - City:LYONS
Practice Address - State:NY
Practice Address - Zip Code:14489-9133
Practice Address - Country:US
Practice Address - Phone:315-946-5722
Practice Address - Fax:315-946-7109
Is Sole Proprietor?:No
Enumeration Date:2007-04-25
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY253835-1163WP0808X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163WP0808XNursing Service ProvidersRegistered NursePsychiatric/Mental Health