Provider Demographics
NPI:1952580458
Name:LERUM, CAROLYN W (NP)
Entity type:Individual
Prefix:
First Name:CAROLYN
Middle Name:W
Last Name:LERUM
Suffix:
Gender:F
Credentials:NP
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Mailing Address - Street 1:2209 GENESEE STREET
Mailing Address - Street 2:BUSINESS OFFICE ROOM 310
Mailing Address - City:UTICA
Mailing Address - State:NY
Mailing Address - Zip Code:13501
Mailing Address - Country:US
Mailing Address - Phone:315-801-3282
Mailing Address - Fax:315-801-8391
Practice Address - Street 1:1656 CHAMPLIN AVE
Practice Address - Street 2:
Practice Address - City:UTICA
Practice Address - State:NY
Practice Address - Zip Code:13502-4830
Practice Address - Country:US
Practice Address - Phone:315-624-6241
Practice Address - Fax:315-624-6395
Is Sole Proprietor?:No
Enumeration Date:2007-10-31
Last Update Date:2018-03-17
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Provider Licenses
StateLicense IDTaxonomies
NYF360435-1363LX0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LX0001XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerObstetrics & Gynecology
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY03577277Medicaid
NYF360435-1OtherLICENSE