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Individual

ANN LODGE

Active
Sole proprietor
Yes

Provider details

NPI number
Gender
F
Credential
RN

Contact information

Practice address
53 DOWNEY DRIVE, OSWEGO, NY 13126
(610) 209-3706
(610) 209-3706
Mailing address
53 DOWNEY DR, OSWEGO, NY 13126-6133
(610) 209-3706

Taxonomy

Speciality
Code
Description
License number
State
163W00000X
Registered Nurse
Primary
587237
NY

Other

Other identifiers
Code
Description
Identifier
Issuer
State
05
02882328
NY
Enumeration date
10/05/2007
Last updated
04/09/2014
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