Provider Demographics
NPI:1437406535
Name:FUSARO, NICHOLAS VINCENT (LPN)
Entity Type:Individual
Prefix:
First Name:NICHOLAS
Middle Name:VINCENT
Last Name:FUSARO
Suffix:
Gender:M
Credentials:LPN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:35 KOHLANARIS DR
Mailing Address - Street 2:
Mailing Address - City:POUGHKEEPSIE
Mailing Address - State:NY
Mailing Address - Zip Code:12601-1632
Mailing Address - Country:US
Mailing Address - Phone:845-489-7352
Mailing Address - Fax:
Practice Address - Street 1:35 KOHLANARIS DR
Practice Address - Street 2:
Practice Address - City:POUGHKEEPSIE
Practice Address - State:NY
Practice Address - Zip Code:12601-1632
Practice Address - Country:US
Practice Address - Phone:845-489-7352
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2012-08-07
Last Update Date:2012-08-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY305158164W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes164W00000XNursing Service ProvidersLicensed Practical Nurse