Individual
MS. LISA J TRICKEY
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
PA C
Contact information
Practice address
1340 WASHINGTON ST, WATERTOWN, NY 13601-4541
(315) 782-9003
(315) 782-9010
Mailing address
53-59 PUBLIC SQUARE, INTERNAL MEDICINE OF NORTHERN NEW YORK SUITE 201, WATERTOWN, NY 13601-2674
(315) 782-4950
(315) 782-3699
Taxonomy
Speciality
Code
Description
License number
State
363AM0700X
Medical Physician Assistant
Primary
0050661
NY
Other
Enumeration date
08/15/2005
Last updated
03/07/2023
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