Provider Demographics
NPI:1326317926
Name:LANOUE, ANTOINETTE MARIE (RN)
Entity Type:Individual
Prefix:
First Name:ANTOINETTE
Middle Name:MARIE
Last Name:LANOUE
Suffix:
Gender:F
Credentials:RN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:146 GETTLE RD # 1
Mailing Address - Street 2:
Mailing Address - City:AVERILL PARK
Mailing Address - State:NY
Mailing Address - Zip Code:12018-9794
Mailing Address - Country:US
Mailing Address - Phone:518-674-7068
Mailing Address - Fax:518-674-7121
Practice Address - Street 1:333 NY 351
Practice Address - Street 2:
Practice Address - City:AVERILL PARK
Practice Address - State:NY
Practice Address - Zip Code:12018-9794
Practice Address - Country:US
Practice Address - Phone:518-674-7103
Practice Address - Fax:518-674-7121
Is Sole Proprietor?:No
Enumeration Date:2011-12-28
Last Update Date:2011-12-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY3591951163WS0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163WS0200XNursing Service ProvidersRegistered NurseSchool
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY01379024Medicaid