Individual
LAUREN C DERRICK
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
NP
Contact information
Practice address
5112 W TAFT RD STE J, LIVERPOOL, NY 13088-4866
(315) 701-2170
(315) 701-2185
Mailing address
510 TOWNE DR, FAYETTEVILLE, NY 13066-1331
(315) 663-0500
(315) 663-0514
Taxonomy
Speciality
Code
Description
License number
State
363LA2200X
Adult Health Nurse Practitioner
Primary
301621
NY
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
01980230
—
NY
Enumeration date
07/11/2005
Last updated
09/26/2019
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