Provider Demographics
NPI:1366653768
Name:NERVINA, BARBARA ANN (LPN)
Entity Type:Individual
Prefix:
First Name:BARBARA
Middle Name:ANN
Last Name:NERVINA
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 1:11328 DRAKE RD
Mailing Address - Street 2:
Mailing Address - City:CATO
Mailing Address - State:NY
Mailing Address - Zip Code:13033
Mailing Address - Country:US
Mailing Address - Phone:315-626-2630
Mailing Address - Fax:
Practice Address - Street 1:11328 DRAKE RD
Practice Address - Street 2:
Practice Address - City:CATO
Practice Address - State:NY
Practice Address - Zip Code:13033-3258
Practice Address - Country:US
Practice Address - Phone:315-626-2630
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-05-25
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY168548-1164W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes164W00000XNursing Service ProvidersLicensed Practical Nurse