Individual
LISA DWELLO
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
PA
Contact information
Practice address
160 STONE ST, WATERTOWN, NY 13601-3261
(315) 788-8065
Mailing address
2697 MAIN ST, BUFFALO, NY 14214-1701
(716) 831-2200
Taxonomy
Speciality
Code
Description
License number
State
363AM0700X
Medical Physician Assistant
Primary
025477
NY
Other
Enumeration date
08/18/2020
Last updated
08/18/2020
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