Provider Demographics
NPI:1114118668
Name:LANSIGNOT, MARY MAGDELENE (RN)
Entity Type:Individual
Prefix:MISS
First Name:MARY
Middle Name:MAGDELENE
Last Name:LANSIGNOT
Suffix:
Gender:F
Credentials:RN
Other - Prefix:MRS
Other - First Name:MARY
Other - Middle Name:MAGDELENE
Other - Last Name:WILLIAMS
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:RN
Mailing Address - Street 1:970 EAST 49 STREET
Mailing Address - Street 2:APT 1
Mailing Address - City:BROOKLYN
Mailing Address - State:NY
Mailing Address - Zip Code:11203
Mailing Address - Country:US
Mailing Address - Phone:718-451-3234
Mailing Address - Fax:
Practice Address - Street 1:250 FORT WASHINGTON AVENUE
Practice Address - Street 2:APT 2C
Practice Address - City:NEW YORK
Practice Address - State:NY
Practice Address - Zip Code:10032
Practice Address - Country:US
Practice Address - Phone:212-927-3801
Practice Address - Fax:212-927-3801
Is Sole Proprietor?:No
Enumeration Date:2007-08-08
Last Update Date:2007-08-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY479285163W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163W00000XNursing Service ProvidersRegistered Nurse
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY01947020Medicaid