Provider Demographics
NPI:1447402755
Name:NATHAN, SONYA RENEE (LPN)
Entity Type:Individual
Prefix:MISS
First Name:SONYA
Middle Name:RENEE
Last Name:NATHAN
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 1:588 GENESEE ST
Mailing Address - Street 2:
Mailing Address - City:ROCHESTER
Mailing Address - State:NY
Mailing Address - Zip Code:14611-3652
Mailing Address - Country:US
Mailing Address - Phone:585-529-5629
Mailing Address - Fax:585-529-5629
Practice Address - Street 1:588 GENESEE ST
Practice Address - Street 2:
Practice Address - City:ROCHESTER
Practice Address - State:NY
Practice Address - Zip Code:14611-3652
Practice Address - Country:US
Practice Address - Phone:585-529-5629
Practice Address - Fax:585-529-5629
Is Sole Proprietor?:Yes
Enumeration Date:2008-10-17
Last Update Date:2008-10-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY2380721164W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes164W00000XNursing Service ProvidersLicensed Practical Nurse