Individual
LISA A. CICO
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
NP
Contact information
Practice address
90 PRESIDENTIAL PLZ, 1ST FLOOR, SYRACUSE, NY 13202-2240
(315) 464-8224
(315) 464-2187
Mailing address
750 E ADAMS ST, DEPARTMENT OF SURGERY, SYRACUSE, NY 13210-2306
(315) 464-6278
(315) 464-6365
Taxonomy
Speciality
Code
Description
License number
State
163W00000X
Registered Nurse
375214
NY
363LA2200X
Adult Health Nurse Practitioner
Primary
302361
NY
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
03507462
—
NY
Enumeration date
08/14/2006
Last updated
04/22/2013
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