Provider Demographics
NPI:1174824171
Name:WELLINGTON, LISA A (LPN)
Entity Type:Individual
Prefix:MS
First Name:LISA
Middle Name:A
Last Name:WELLINGTON
Suffix:
Gender:F
Credentials:LPN
Other - Prefix:MS
Other - First Name:LISA
Other - Middle Name:A
Other - Last Name:MAZUCHOWSKI
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:LPN
Mailing Address - Street 1:9632 WILLEY RD
Mailing Address - Street 2:
Mailing Address - City:ARKPORT
Mailing Address - State:NY
Mailing Address - Zip Code:14807-9320
Mailing Address - Country:US
Mailing Address - Phone:607-382-5200
Mailing Address - Fax:
Practice Address - Street 1:9632 WILLEY RD
Practice Address - Street 2:
Practice Address - City:ARKPORT
Practice Address - State:NY
Practice Address - Zip Code:14807-9320
Practice Address - Country:US
Practice Address - Phone:607-382-5200
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2010-11-06
Last Update Date:2010-11-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY237492-1164W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes164W00000XNursing Service ProvidersLicensed Practical Nurse