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Individual

MS. DEANNA MARIE LIPSCOMB

Active
Sole proprietor
No

Provider details

NPI number
Gender
F
Credential
PA-C

Contact information

Practice address
1 PEPSI COLA DR, JHU HEALTH AND WELLNESS CENTER, LATHAM, NY 12110-2306
(518) 782-2479
Mailing address
1 PEPSI COLA DR, LATHAM, NY 12110-2306
(518) 782-2479
(518) 783-2634

Taxonomy

Speciality
Code
Description
License number
State
363A00000X
Physician Assistant
Primary
012912
NY

Other

Other identifiers
Code
Description
Identifier
Issuer
State
05
03524747
NY
Enumeration date
12/09/2008
Last updated
03/24/2026
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