Provider Demographics
NPI:1477214666
Name:LANZAFAME, TINA ANN
Entity Type:Individual
Prefix:
First Name:TINA
Middle Name:ANN
Last Name:LANZAFAME
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:TINA
Other - Middle Name:ANN
Other - Last Name:SHAFFER
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:235 W 7TH ST
Mailing Address - Street 2:
Mailing Address - City:OSWEGO
Mailing Address - State:NY
Mailing Address - Zip Code:13126-3650
Mailing Address - Country:US
Mailing Address - Phone:315-263-4783
Mailing Address - Fax:
Practice Address - Street 1:235 W 7TH ST
Practice Address - Street 2:
Practice Address - City:OSWEGO
Practice Address - State:NY
Practice Address - Zip Code:13126-3650
Practice Address - Country:US
Practice Address - Phone:315-263-4783
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2022-01-10
Last Update Date:2022-01-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY333406164W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes164W00000XNursing Service ProvidersLicensed Practical Nurse