Provider Demographics
NPI:1093140279
Name:ELLIOTT, LAKISHA ANN (LPN)
Entity Type:Individual
Prefix:MRS
First Name:LAKISHA
Middle Name:ANN
Last Name:ELLIOTT
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 1:11 CAROL DR
Mailing Address - Street 2:
Mailing Address - City:ADAMS
Mailing Address - State:NY
Mailing Address - Zip Code:13605-1167
Mailing Address - Country:US
Mailing Address - Phone:315-775-6937
Mailing Address - Fax:
Practice Address - Street 1:11 CAROL DR
Practice Address - Street 2:
Practice Address - City:ADAMS
Practice Address - State:NY
Practice Address - Zip Code:13605-1167
Practice Address - Country:US
Practice Address - Phone:315-775-6937
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2013-09-06
Last Update Date:2013-09-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY315881164W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes164W00000XNursing Service ProvidersLicensed Practical Nurse