Provider Demographics
NPI:1275974933
Name:LANSIQUOT, KAETHLEEN DEANNA (LPN)
Entity Type:Individual
Prefix:MRS
First Name:KAETHLEEN
Middle Name:DEANNA
Last Name:LANSIQUOT
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 1:160 NAVY WALK
Mailing Address - Street 2:APT 6A
Mailing Address - City:BROOKLYN
Mailing Address - State:NY
Mailing Address - Zip Code:11201-3277
Mailing Address - Country:US
Mailing Address - Phone:347-339-0605
Mailing Address - Fax:
Practice Address - Street 1:160 NAVY WALK
Practice Address - Street 2:APT 6A
Practice Address - City:BROOKLYN
Practice Address - State:NY
Practice Address - Zip Code:11201-3277
Practice Address - Country:US
Practice Address - Phone:347-339-0605
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2013-07-10
Last Update Date:2013-07-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY314463-1164W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes164W00000XNursing Service ProvidersLicensed Practical Nurse