Provider Demographics
NPI:1124359948
Name:PAGAN, LEIDA
Entity Type:Individual
Prefix:
First Name:LEIDA
Middle Name:
Last Name:PAGAN
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 1:260 INDIAN CHURCH RD
Mailing Address - Street 2:
Mailing Address - City:WEST SENECA
Mailing Address - State:NY
Mailing Address - Zip Code:14210-1944
Mailing Address - Country:US
Mailing Address - Phone:716-446-3983
Mailing Address - Fax:
Practice Address - Street 1:260 INDIAN CHURCH RD
Practice Address - Street 2:
Practice Address - City:WEST SENECA
Practice Address - State:NY
Practice Address - Zip Code:14210-1944
Practice Address - Country:US
Practice Address - Phone:716-446-3983
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2010-01-18
Last Update Date:2010-01-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY239014-1164W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes164W00000XNursing Service ProvidersLicensed Practical Nurse