Provider Demographics
NPI:1003398124
Name:FRUSTER, PERTRINA CASSANDRA (LPN)
Entity Type:Individual
Prefix:
First Name:PERTRINA
Middle Name:CASSANDRA
Last Name:FRUSTER
Suffix:
Gender:F
Credentials:LPN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:24 HILL CT APT E
Mailing Address - Street 2:
Mailing Address - City:ROCHESTER
Mailing Address - State:NY
Mailing Address - Zip Code:14621-1181
Mailing Address - Country:US
Mailing Address - Phone:917-982-0399
Mailing Address - Fax:
Practice Address - Street 1:24 HILL CT APT E
Practice Address - Street 2:
Practice Address - City:ROCHESTER
Practice Address - State:NY
Practice Address - Zip Code:14621-1181
Practice Address - Country:US
Practice Address - Phone:917-982-0399
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2018-09-05
Last Update Date:2018-09-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY232290164W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes164W00000XNursing Service ProvidersLicensed Practical NurseGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY232290OtherLPN LICENSE