Individual
KEVIN WAYNE LAVINE
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
NP
Contact information
Practice address
301 PROSPECT AVE, SYRACUSE, NY 13203-1807
(315) 448-5704
Mailing address
4953 DARIEN DR, LIVERPOOL, NY 13088-5801
Taxonomy
Speciality
Code
Description
License number
State
363LA2100X
Acute Care Nurse Practitioner
Primary
431135
NY
Other
Enumeration date
08/01/2017
Last updated
08/01/2017
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