Provider Demographics
NPI:1871824094
Name:LIS, SUSAN R (RN)
Entity Type:Individual
Prefix:
First Name:SUSAN
Middle Name:R
Last Name:LIS
Suffix:
Gender:F
Credentials:RN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:319 CENTRAL AVE
Mailing Address - Street 2:HEALTH DEPARTMENT 3RD FLOOR
Mailing Address - City:DUNKIRK
Mailing Address - State:NY
Mailing Address - Zip Code:14048-2137
Mailing Address - Country:US
Mailing Address - Phone:716-363-3660
Mailing Address - Fax:716-363-3629
Practice Address - Street 1:319 CENTRAL AVE
Practice Address - Street 2:HEALTH DEPARTMENT 3RD FLOOR
Practice Address - City:DUNKIRK
Practice Address - State:NY
Practice Address - Zip Code:14048-2137
Practice Address - Country:US
Practice Address - Phone:716-363-3660
Practice Address - Fax:716-363-3629
Is Sole Proprietor?:No
Enumeration Date:2010-01-28
Last Update Date:2010-01-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY394682163W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163W00000XNursing Service ProvidersRegistered Nurse
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY0OtherCHAUTAUQUA COUNTY HEALTH DEPARTMENT