Independent US Healthcare Provider Directory & Public Medical Database
Active NPI 1437374642 Individual Practitioner Female Practitioner

Lisa M Distin , LPN

Licensed Practical Nurse • Tully, NY

Professional Overview & Biography Verified Profile Summary

Lisa Distin, LPN is a registered healthcare professional specializing in Licensed Practical Nurse in Tully, NY. Practice services are available at 4849 OTISCO RD under active NPI credentials.

Practice Location & Contact Primary Location

Practice Address

4849 Otisco Rd

Tully, NY 131593086

Telephone 3156968592

Specialty Benchmarks & Practice Insights

Comparative analytics for Licensed Practical Nurse in Tully, NY

Active Practitioner
Practitioner Clinical Experience
Active
City Avg: 10.5 Yrs
State Avg: 8.0 Yrs
Regional Practice Density
4 Specialists

Practicing in Tully, NY (23738 Statewide)

Telehealth Adoption Rate
0.0% Regional Adoption

In-Person Office Visits Only

Medicare Pricing Discount
67.4% Avg Savings

Under CMS Medicare Fee Schedule vs Standard Submitted Charges

Medical Specialties & State Licenses

Licensed Practical Nurse Primary Specialty

NUCC Taxonomy Code: 164W00000X

State License NY 238458-1

An individual with post-high school vocational training and practical experience in the provision of nursing care at a level less than that required for certification as a Registered Nurse. Requirements for education, experience, licensure, and job responsibilities vary among the states.

Additional State Medicaid & Healthcare Payer Identifiers

Medicaid State Provider ID
01789642 (NY)

Practice Associates & Co-Workers

Healthcare professionals and specialists practicing at this location or sharing practice phone/fax

1 Associated Practitioners
Amy Galletta , LPN

Licensed Practical Nurse

NPI 1922124296

Licensed Practical Nurse

Career & Practice History Timeline

Chronological log of verified NPI updates, location relocations, credentials, and registry changes

6 Historical Events
NPI Profile Active July 09, 2007

NPI status registered as active in NPPES database

📍
Updated Practice Location July 09, 2007

Registered at 4849 OTISCO RD, TULLY, NY 131593086 (Tel: 3156968592)

📍
Updated Business Mailing Address July 09, 2007

Registered at 733 MIDDLE RD, OSWEGO, NY 131265888 (Tel: 3153432390)

👤
Provider Name / Credentials Updated July 09, 2007

Recorded as LISA DISTIN, LPN

🎓
Medical Taxonomy / Specialty Registered (Primary Specialty) July 09, 2007

Licensed Practical Nurse (License #238458-1 in NY)

🟢
Initial NPI Registration & Enumeration April 13, 2007

First registered as active Individual Practitioner in NPPES Database.

Patient & Community Reviews

Verified patient ratings, medical care experiences, and facility photos

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NPI Administrative Meta

NPI Number: 1437374642
Entity Type:
Individual Provider Physician, Nurse Practitioner, or Solo Healthcare Professional (Type 1 NPI)
Enumeration Date: April 13, 2007
Last Update: July 09, 2007
Sole Proprietor: Yes

Mailing Address

733 Middle Rd

Oswego, NY 131265888

Phone: 3153432390

Public Domain Record This profile contains public domain information published by CMS and NPPES under the Freedom of Information Act (FOIA).
⚠️ Medical Disclaimer

This directory listing is for informational purposes only and does not constitute medical advice, diagnosis, or physician endorsement. If you are experiencing a medical emergency, please call 911 immediately.