Provider Demographics
NPI:1467623785
Name:MASCIADRELLI, LISA MARIE (LPN)
Entity Type:Individual
Prefix:
First Name:LISA
Middle Name:MARIE
Last Name:MASCIADRELLI
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 1:28 RAVINE AVE
Mailing Address - Street 2:2ND FLOOR
Mailing Address - City:GLEN COVE
Mailing Address - State:NY
Mailing Address - Zip Code:11542-2733
Mailing Address - Country:US
Mailing Address - Phone:516-996-1260
Mailing Address - Fax:516-584-2536
Practice Address - Street 1:28 RAVINE AVE
Practice Address - Street 2:2ND FLOOR
Practice Address - City:GLEN COVE
Practice Address - State:NY
Practice Address - Zip Code:11542-2733
Practice Address - Country:US
Practice Address - Phone:516-996-1260
Practice Address - Fax:516-584-2536
Is Sole Proprietor?:Yes
Enumeration Date:2008-03-14
Last Update Date:2008-03-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY271641164W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes164W00000XNursing Service ProvidersLicensed Practical Nurse