Individual
CAROLYN W LERUM
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
NP
Contact information
Practice address
1656 CHAMPLIN AVE, UTICA, NY 13502-4830
(315) 624-6241
(315) 624-6395
Mailing address
2209 GENESEE STREET, BUSINESS OFFICE ROOM 310, UTICA, NY 13501
(315) 801-3282
(315) 801-8391
Taxonomy
Speciality
Code
Description
License number
State
363LX0001X
Obstetrics & Gynecology Nurse Practitioner
Primary
F360435-1
NY
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
03577277
—
NY
01
—
F360435-1
LICENSE
NY
Enumeration date
10/31/2007
Last updated
03/17/2018
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