Provider Demographics
NPI:1417495227
Name:CLANCY, ERIN M (LPN)
Entity Type:Individual
Prefix:MS
First Name:ERIN
Middle Name:M
Last Name:CLANCY
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 1:24 W MASEM SQ
Mailing Address - Street 2:
Mailing Address - City:EAST PATCHOGUE
Mailing Address - State:NY
Mailing Address - Zip Code:11772-5620
Mailing Address - Country:US
Mailing Address - Phone:631-317-8741
Mailing Address - Fax:
Practice Address - Street 1:24 W MASEM SQ
Practice Address - Street 2:
Practice Address - City:EAST PATCHOGUE
Practice Address - State:NY
Practice Address - Zip Code:11772-5620
Practice Address - Country:US
Practice Address - Phone:631-317-8741
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2017-02-01
Last Update Date:2017-02-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY259077-1164W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes164W00000XNursing Service ProvidersLicensed Practical Nurse