Provider Demographics
NPI:1912245200
Name:STUPP, LAINA MARLENE (FNP)
Entity Type:Individual
Prefix:MRS
First Name:LAINA
Middle Name:MARLENE
Last Name:STUPP
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Gender:F
Credentials:FNP
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Mailing Address - Street 1:1 RUDOLPH RD
Mailing Address - Street 2:MARY WALKER HEALTH CENTER SUNY OSWEGO BLDG #10
Mailing Address - City:OSWEGO
Mailing Address - State:NY
Mailing Address - Zip Code:13126
Mailing Address - Country:US
Mailing Address - Phone:315-312-4100
Mailing Address - Fax:315-312-5409
Practice Address - Street 1:1 RUDOLPH RD
Practice Address - Street 2:MARY WALKER HEALTH CENTER SUNY OSWEGO BLDG #10
Practice Address - City:OSWEGO
Practice Address - State:NY
Practice Address - Zip Code:13126
Practice Address - Country:US
Practice Address - Phone:315-312-4100
Practice Address - Fax:315-312-5409
Is Sole Proprietor?:No
Enumeration Date:2013-01-22
Last Update Date:2016-02-15
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Provider Licenses
StateLicense IDTaxonomies
NYF337977-1363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily