Provider Demographics
NPI:1235394552
Name:PRZYWARA, ROSANNE (LPN)
Entity Type:Individual
Prefix:MRS
First Name:ROSANNE
Middle Name:
Last Name:PRZYWARA
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 1:254 THREE ROD RD
Mailing Address - Street 2:
Mailing Address - City:ALDEN
Mailing Address - State:NY
Mailing Address - Zip Code:14004-9480
Mailing Address - Country:US
Mailing Address - Phone:716-361-2574
Mailing Address - Fax:
Practice Address - Street 1:254 THREE ROD RD
Practice Address - Street 2:
Practice Address - City:ALDEN
Practice Address - State:NY
Practice Address - Zip Code:14004-9480
Practice Address - Country:US
Practice Address - Phone:716-361-2574
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2008-07-25
Last Update Date:2008-07-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY104559-1164W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes164W00000XNursing Service ProvidersLicensed Practical Nurse