Provider Demographics
NPI:1386843738
Name:MINER, NANCY ANN (LPN)
Entity Type:Individual
Prefix:
First Name:NANCY
Middle Name:ANN
Last Name:MINER
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 1:2028 BERWYN RD
Mailing Address - Street 2:
Mailing Address - City:LA FAYETTE
Mailing Address - State:NY
Mailing Address - Zip Code:13084-9404
Mailing Address - Country:US
Mailing Address - Phone:315-683-5511
Mailing Address - Fax:
Practice Address - Street 1:2028 BERWYN RD
Practice Address - Street 2:
Practice Address - City:LA FAYETTE
Practice Address - State:NY
Practice Address - Zip Code:13084-9404
Practice Address - Country:US
Practice Address - Phone:315-683-5511
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-07-16
Last Update Date:2008-05-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY02548236164W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes164W00000XNursing Service ProvidersLicensed Practical Nurse