Provider Demographics
NPI:1548372790
Name:PADDEN, LORRAINE (ANP)
Entity type:Individual
Prefix:
First Name:LORRAINE
Middle Name:
Last Name:PADDEN
Suffix:
Gender:F
Credentials:ANP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:475 IRVING AVE
Mailing Address - Street 2:SUITE 418
Mailing Address - City:SYRACUSE
Mailing Address - State:NY
Mailing Address - Zip Code:13210-1756
Mailing Address - Country:US
Mailing Address - Phone:315-475-3999
Mailing Address - Fax:315-470-4014
Practice Address - Street 1:475 IRVING AVE
Practice Address - Street 2:SUITE 418
Practice Address - City:SYRACUSE
Practice Address - State:NY
Practice Address - Zip Code:13210-1756
Practice Address - Country:US
Practice Address - Phone:315-475-3999
Practice Address - Fax:315-470-4014
Is Sole Proprietor?:No
Enumeration Date:2006-08-31
Last Update Date:2015-01-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY301109363LA2200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LA2200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerAdult Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
NYS98004Medicare UPIN