1811410236 NPI number — LINDSEY DEBORAH SANBORN FNP

Table of content: LINDSEY DEBORAH SANBORN FNP (NPI 1811410236)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1811410236 NPI number — LINDSEY DEBORAH SANBORN FNP

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
SANBORN
Provider First Name:
LINDSEY
Provider Middle Name:
DEBORAH
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
FNP
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
BOE
Provider Other First Name:
LINDSEY
Provider Other Middle Name:
DEBORAH
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
FNP
Provider Other Last Name Type Code:
1

NPI Number Information

NPI Number:
1811410236
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
06/25/2020
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
414 OLD COVE RD
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
LIVERPOOL
Provider Business Mailing Address State Name:
NY
Provider Business Mailing Address Postal Code:
13090
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
585-802-3155
Provider Business Mailing Address Fax Number:

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
301 PROSPECT AVENUE ST. JOSEPHS'S HOSPITAL HEALTH CENTE
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
SYRACUSE
Provider Business Practice Location Address State Name:
NY
Provider Business Practice Location Address Postal Code:
13203
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
315-481-8345
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
07/18/2017

Additional Information

			
		

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 363LF0000X , with the licence number:  342084 , registered in the state of NY ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)