Lisa Marie Macedonia Olofson, LICENSED REGISTERED

Primary specialty

Registered NurseTaxonomy code 163W00000X

License

415592 Issued in NY

Practice address

9 Corral Lane
East Northport, NY 11731

Phone

(631) 368-0169

NPI assigned

Nov 19, 2007

Sex

Female

Sole proprietor

Yes

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 1

Addresses

Other identifiers 1

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Not enrolled

State licenses

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1195430400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1195430400000",
    "number": "1851572812",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "9 CORRAL LANE",
            "city": "EAST NORTHPORT",
            "state": "NY",
            "postal_code": "11731",
            "telephone_number": "631-368-0169"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "9 CORRAL LANE",
            "city": "EAST NORTHPORT",
            "state": "NY",
            "postal_code": "11731",
            "telephone_number": "631-368-0169"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "MACEDONIA OLOFSON",
        "first_name": "LISA",
        "middle_name": "MARIE",
        "name_prefix": "Mrs.",
        "credential": "LICENSED REGISTERED",
        "sole_proprietor": "YES",
        "sex": "F",
        "enumeration_date": "2007-11-19",
        "last_updated": "2007-11-19",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "163W00000X",
            "taxonomy_group": "",
            "desc": "Registered Nurse",
            "state": "NY",
            "license": "415592",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "02638113",
            "state": "NY"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Kristen Lucano
• Aretha Lui, DOCTOR OF PHARMACY
• Lux Eye Care Studio Optometry PC
• Mario Macari, RPH
• Nicole Rose Macari, MS, CCC-SLP, TSSLD
• Daniel Vincent Mackey, PHARMD
• Janis Ann Maguirems, MS ED
• Karen Maher
• Linda Mary Malloy-Buonanno, O.T.
• Amanda Manfredo, PHARMD

• Registered Nurse in East Northport, NY
• Providers in East Northport, NY by specialty
• Registered Nurse in New York

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Nov 19, 2007; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.