Provider Demographics
NPI:1336147016
Name:JEWELL, LORNA LEAH (NPP)
Entity Type:Individual
Prefix:MISS
First Name:LORNA
Middle Name:LEAH
Last Name:JEWELL
Suffix:
Gender:F
Credentials:NPP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:65 PARK ST
Mailing Address - Street 2:EAST WING
Mailing Address - City:MALONE
Mailing Address - State:NY
Mailing Address - Zip Code:12953-1239
Mailing Address - Country:US
Mailing Address - Phone:518-483-0454
Mailing Address - Fax:518-483-5567
Practice Address - Street 1:65 PARK ST
Practice Address - Street 2:WEST WING
Practice Address - City:MALONE
Practice Address - State:NY
Practice Address - Zip Code:12953-1239
Practice Address - Country:US
Practice Address - Phone:518-483-0454
Practice Address - Fax:518-483-5567
Is Sole Proprietor?:Yes
Enumeration Date:2005-07-07
Last Update Date:2015-06-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY329314363LP0808X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP0808XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPsychiatric/Mental Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
785899OtherMVP
NY02249714Medicaid
NY7407347OtherVALUE OPTIONS
CC4355Medicare UPIN
S89189Medicare ID - Type Unspecified