Provider Demographics
NPI:1437207669
Name:BOISMENU, CAROL ANN (LPN)
Entity Type:Individual
Prefix:
First Name:CAROL
Middle Name:ANN
Last Name:BOISMENU
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 1:4478 HAAG RD.
Mailing Address - Street 2:
Mailing Address - City:EDEN
Mailing Address - State:NY
Mailing Address - Zip Code:14057
Mailing Address - Country:US
Mailing Address - Phone:716-992-3055
Mailing Address - Fax:
Practice Address - Street 1:4478 HAAG RD
Practice Address - Street 2:
Practice Address - City:EDEN
Practice Address - State:NY
Practice Address - Zip Code:14057-9726
Practice Address - Country:US
Practice Address - Phone:716-992-3055
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-01-05
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY078483164W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes164W00000XNursing Service ProvidersLicensed Practical Nurse