Provider Demographics
NPI:1114372935
Name:ESPOSITO, SUZANNE (LPN)
Entity Type:Individual
Prefix:
First Name:SUZANNE
Middle Name:
Last Name:ESPOSITO
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 1:20 LOCK ST
Mailing Address - Street 2:
Mailing Address - City:LOCKPORT
Mailing Address - State:NY
Mailing Address - Zip Code:14094-2812
Mailing Address - Country:US
Mailing Address - Phone:716-433-1937
Mailing Address - Fax:716-433-1266
Practice Address - Street 1:624 RIVER RD
Practice Address - Street 2:
Practice Address - City:NORTH TONAWANDA
Practice Address - State:NY
Practice Address - Zip Code:14120-6563
Practice Address - Country:US
Practice Address - Phone:716-693-9961
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2016-04-29
Last Update Date:2016-04-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY170859-1164W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes164W00000XNursing Service ProvidersLicensed Practical Nurse