Provider Demographics
NPI:1114176013
Name:CLANCY, LUCINDA
Entity Type:Individual
Prefix:
First Name:LUCINDA
Middle Name:
Last Name:CLANCY
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:807 PARKSIDE DR
Mailing Address - Street 2:
Mailing Address - City:LIMESTONE
Mailing Address - State:NY
Mailing Address - Zip Code:14753-9778
Mailing Address - Country:US
Mailing Address - Phone:716-925-8943
Mailing Address - Fax:
Practice Address - Street 1:807 PARKSIDE DR
Practice Address - Street 2:
Practice Address - City:LIMESTONE
Practice Address - State:NY
Practice Address - Zip Code:14753-9778
Practice Address - Country:US
Practice Address - Phone:716-925-8943
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2008-09-16
Last Update Date:2008-09-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY231169164W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes164W00000XNursing Service ProvidersLicensed Practical Nurse