Provider Demographics
NPI:1366877540
Name:GAGNE, LANA CATHERINE (NP)
Entity type:Individual
Prefix:
First Name:LANA
Middle Name:CATHERINE
Last Name:GAGNE
Suffix:
Gender:F
Credentials:NP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1000 E GENESEE ST
Mailing Address - Street 2:STE 500
Mailing Address - City:SYRACUSE
Mailing Address - State:NY
Mailing Address - Zip Code:13210-1885
Mailing Address - Country:US
Mailing Address - Phone:760-243-4009
Mailing Address - Fax:760-243-3255
Practice Address - Street 1:1000 E GENESEE ST
Practice Address - Street 2:STE 500
Practice Address - City:SYRACUSE
Practice Address - State:NY
Practice Address - Zip Code:13210-1885
Practice Address - Country:US
Practice Address - Phone:315-471-8388
Practice Address - Fax:315-471-8019
Is Sole Proprietor?:No
Enumeration Date:2013-09-06
Last Update Date:2017-02-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NYF338092-1363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily