Provider Demographics
NPI:1780068221
Name:LAVINE, LAUREN E (NP)
Entity type:Individual
Prefix:MRS
First Name:LAUREN
Middle Name:E
Last Name:LAVINE
Suffix:
Gender:F
Credentials:NP
Other - Prefix:
Other - First Name:LAUREN
Other - Middle Name:E
Other - Last Name:GILDEMEYER
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:6846 BUCKLEY ROAD
Mailing Address - Street 2:NEPHROLOGY HYPERTENSION ASSOCIATES OF CNY, PC
Mailing Address - City:NORTH SYRACUSE
Mailing Address - State:NY
Mailing Address - Zip Code:13212
Mailing Address - Country:US
Mailing Address - Phone:315-410-6400
Mailing Address - Fax:315-410-6410
Practice Address - Street 1:6846 BUCKLEY ROAD
Practice Address - Street 2:NEPHROLOGY HYPERTENSION ASSOCIATES OF CNY, PC
Practice Address - City:NORTH SYRACUSE
Practice Address - State:NY
Practice Address - Zip Code:13212
Practice Address - Country:US
Practice Address - Phone:315-410-6400
Practice Address - Fax:315-410-6410
Is Sole Proprietor?:No
Enumeration Date:2015-07-15
Last Update Date:2015-07-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY339783363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily