| Doctor Name: | LISA A OLSON-GUGERTY |
| NPI Number: | 1083902027 |
| Entity Type Code: | Individual (1) |
| Gender: | F |
| Credentials: | NP |
| License Number: | F336857 |
| Business Practice Address: | 82 Copeland Ave Homer, NY - 130771528 |
| Business Phone Number: | 6077492640 |
| Business Fax Number: | 6077492644 |
| Mailing Address: | 82 Copeland Ave, HOMER |
| State: | NY |
| Postal Code: | 130771528 |
| Phone Number: | 6077492640 |
| Fax Number: | 6077492644 |
| NPI Enumeration Date: | 07/12/2011 |
| NPI Last Update Date: | 08/23/2013 |
| Replacement NPI: | 0 |
| NPI Deactivation Date: | |
| NPI Reactivation Date: |
Taxonomy Information: | |
| Healthcare Provider Taxonomy: | 363LF0000X |
| License Number: | F336857 |
| Healthcare Provider Taxonomy: (Secondary) | Y |
| State: | NY |
| Taxonomy Type: | Physician Assistants & Advanced Practice Nursing Providers |
| Taxonomy Classification: | Nurse Practitioner |
| Taxonomy Specialization: | Family |
| Taxonomy Definition: | |