Provider Demographics
NPI:1407024706
Name:LACLAIRE, BRIDGET YVONEE (LPN)
Entity Type:Individual
Prefix:
First Name:BRIDGET
Middle Name:YVONEE
Last Name:LACLAIRE
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 1:5076 ROUTE 365
Mailing Address - Street 2:PO BOX 116
Mailing Address - City:VERONA
Mailing Address - State:NY
Mailing Address - Zip Code:13478-3104
Mailing Address - Country:US
Mailing Address - Phone:315-363-5956
Mailing Address - Fax:
Practice Address - Street 1:5076 STATE ROUTE 365
Practice Address - Street 2:
Practice Address - City:VERONA
Practice Address - State:NY
Practice Address - Zip Code:13478-3117
Practice Address - Country:US
Practice Address - Phone:315-363-5956
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2008-02-20
Last Update Date:2008-02-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY290660-1164W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes164W00000XNursing Service ProvidersLicensed Practical Nurse