Provider Demographics
NPI:1033106018
Name:LOTTERMOSER, JANET LUCILLE (NP)
Entity type:Individual
Prefix:MS
First Name:JANET
Middle Name:LUCILLE
Last Name:LOTTERMOSER
Suffix:
Gender:F
Credentials:NP
Other - Prefix:MS
Other - First Name:JANET
Other - Middle Name:LUCILLE
Other - Last Name:SWEET
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:ANP
Mailing Address - Street 1:5857 GLENDORA RD
Mailing Address - Street 2:
Mailing Address - City:CICERO
Mailing Address - State:NY
Mailing Address - Zip Code:13039-9571
Mailing Address - Country:US
Mailing Address - Phone:315-699-3830
Mailing Address - Fax:707-471-3830
Practice Address - Street 1:5857 GLENDORA RD
Practice Address - Street 2:
Practice Address - City:CICERO
Practice Address - State:NY
Practice Address - Zip Code:13039-9571
Practice Address - Country:US
Practice Address - Phone:315-699-3830
Practice Address - Fax:707-471-3830
Is Sole Proprietor?:Yes
Enumeration Date:2005-10-04
Last Update Date:2016-10-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NYF300105363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner