Individual
PAUL DAVID LYSTRUP
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
CRNA
Contact information
Practice address
4900 BROAD RD, SYRACUSE, NY 13215-2265
(315) 492-5011
Mailing address
3418 HAMMOCKS DR, APT 308, BALDWINSVILLE, NY 13027-4260
(623) 466-3387
Taxonomy
Speciality
Code
Description
License number
State
163W00000X
Registered Nurse
22 636868
NY
367500000X
Certified Registered Nurse Anesthetist
Primary
636868
NY
Other
Enumeration date
10/24/2010
Last updated
04/26/2011
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