Provider Demographics
NPI:1437478104
Name:CRANDALL, LISA YVONNE (LPN)
Entity Type:Individual
Prefix:
First Name:LISA
Middle Name:YVONNE
Last Name:CRANDALL
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 1:4388 COUNTY ROAD 16
Mailing Address - Street 2:
Mailing Address - City:ANGELICA
Mailing Address - State:NY
Mailing Address - Zip Code:14709-8705
Mailing Address - Country:US
Mailing Address - Phone:585-808-9657
Mailing Address - Fax:
Practice Address - Street 1:2129 STATE ROUTE 19
Practice Address - Street 2:PARK 2 LOT 49
Practice Address - City:WELLSVILLE
Practice Address - State:NY
Practice Address - Zip Code:14895-9420
Practice Address - Country:US
Practice Address - Phone:585-808-4750
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2010-05-20
Last Update Date:2010-05-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY276862-1164W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes164W00000XNursing Service ProvidersLicensed Practical Nurse