Provider Demographics
NPI:1063539617
Name:DOOLITTLE, LISA (NP)
Entity type:Individual
Prefix:MRS
First Name:LISA
Middle Name:
Last Name:DOOLITTLE
Suffix:
Gender:F
Credentials:NP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:348 LAKE RD
Mailing Address - Street 2:
Mailing Address - City:OSWEGO
Mailing Address - State:NY
Mailing Address - Zip Code:13126-5974
Mailing Address - Country:US
Mailing Address - Phone:315-349-7963
Mailing Address - Fax:315-349-7696
Practice Address - Street 1:19 JEFFERSON ST
Practice Address - Street 2:
Practice Address - City:PHOENIX
Practice Address - State:NY
Practice Address - Zip Code:13135-2333
Practice Address - Country:US
Practice Address - Phone:315-349-7963
Practice Address - Fax:315-349-7696
Is Sole Proprietor?:No
Enumeration Date:2007-03-26
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NYF302052363LA2200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LA2200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerAdult Health