Provider Demographics
NPI:1164678389
Name:LANIEWSKI, LISA (LPN)
Entity Type:Individual
Prefix:
First Name:LISA
Middle Name:
Last Name:LANIEWSKI
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 1:650 FRANKLIN ST
Mailing Address - Street 2:SUITE 102
Mailing Address - City:SCHENECTADY
Mailing Address - State:NY
Mailing Address - Zip Code:12305-2168
Mailing Address - Country:US
Mailing Address - Phone:518-374-2117
Mailing Address - Fax:518-374-2426
Practice Address - Street 1:650 FRANKLIN ST
Practice Address - Street 2:SUITE 102
Practice Address - City:SCHENECTADY
Practice Address - State:NY
Practice Address - Zip Code:12305-2168
Practice Address - Country:US
Practice Address - Phone:518-374-2117
Practice Address - Fax:518-374-2426
Is Sole Proprietor?:Yes
Enumeration Date:2008-08-08
Last Update Date:2008-08-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY2700741164W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes164W00000XNursing Service ProvidersLicensed Practical Nurse