Provider Demographics
NPI:1093253882
Name:ABBINANTE, VANESSA LYNNE (RN)
Entity Type:Individual
Prefix:
First Name:VANESSA
Middle Name:LYNNE
Last Name:ABBINANTE
Suffix:
Gender:F
Credentials:RN
Other - Prefix:
Other - First Name:VANESSA
Other - Middle Name:
Other - Last Name:BURKE
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:LPN
Mailing Address - Street 1:40 GROVE RD
Mailing Address - Street 2:
Mailing Address - City:WILLOW
Mailing Address - State:NY
Mailing Address - Zip Code:12495-5107
Mailing Address - Country:US
Mailing Address - Phone:845-688-5057
Mailing Address - Fax:
Practice Address - Street 1:40 GROVE RD
Practice Address - Street 2:
Practice Address - City:WILLOW
Practice Address - State:NY
Practice Address - Zip Code:12495-5107
Practice Address - Country:US
Practice Address - Phone:845-688-5057
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2017-02-01
Last Update Date:2020-05-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY320426-1164W00000X
NY774728-01163WH0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163WH0200XNursing Service ProvidersRegistered NurseHome Health
No164W00000XNursing Service ProvidersLicensed Practical Nurse
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY04690873Medicaid