Provider Demographics
NPI:1174855068
Name:CASEY, PATRICIA L (LPN)
Entity Type:Individual
Prefix:MS
First Name:PATRICIA
Middle Name:L
Last Name:CASEY
Suffix:
Gender:F
Credentials:LPN
Other - Prefix:MRS
Other - First Name:PATRICIA
Other - Middle Name:L
Other - Last Name:VANNORTON
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:LPN
Mailing Address - Street 1:780 STATE ROUTE 369
Mailing Address - Street 2:LOT NO. 40
Mailing Address - City:PORT CRANE
Mailing Address - State:NY
Mailing Address - Zip Code:13833-1041
Mailing Address - Country:US
Mailing Address - Phone:607-772-8080
Mailing Address - Fax:607-772-6515
Practice Address - Street 1:780 STATE ROUTE 369
Practice Address - Street 2:LOT NO. 40
Practice Address - City:PORT CRANE
Practice Address - State:NY
Practice Address - Zip Code:13833-1041
Practice Address - Country:US
Practice Address - Phone:607-772-8080
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2010-02-03
Last Update Date:2010-02-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY83663164W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes164W00000XNursing Service ProvidersLicensed Practical Nurse