Provider Demographics
NPI:1336513548
Name:PRESCOD, ALLAN SR (LPN)
Entity Type:Individual
Prefix:
First Name:ALLAN
Middle Name:
Last Name:PRESCOD
Suffix:SR
Gender:M
Credentials:LPN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1400 NOYES ST
Mailing Address - Street 2:
Mailing Address - City:UTICA
Mailing Address - State:NY
Mailing Address - Zip Code:13502-3854
Mailing Address - Country:US
Mailing Address - Phone:315-738-2699
Mailing Address - Fax:315-738-4448
Practice Address - Street 1:1400 NOYES ST
Practice Address - Street 2:
Practice Address - City:UTICA
Practice Address - State:NY
Practice Address - Zip Code:13502-3854
Practice Address - Country:US
Practice Address - Phone:315-738-2699
Practice Address - Fax:315-738-4448
Is Sole Proprietor?:Yes
Enumeration Date:2015-11-25
Last Update Date:2015-11-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY268641164W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes164W00000XNursing Service ProvidersLicensed Practical Nurse