Provider Demographics
NPI:1497193619
Name:OTTALAGANO VINCI, LANETTE ANN (RN)
Entity Type:Individual
Prefix:MRS
First Name:LANETTE
Middle Name:ANN
Last Name:OTTALAGANO VINCI
Suffix:
Gender:F
Credentials:RN
Other - Prefix:MISS
Other - First Name:LANETTE
Other - Middle Name:ANN
Other - Last Name:OTTALAGANO
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:RN
Mailing Address - Street 1:14 SELDEN DR
Mailing Address - Street 2:
Mailing Address - City:ROME
Mailing Address - State:NY
Mailing Address - Zip Code:13440-0901
Mailing Address - Country:US
Mailing Address - Phone:315-533-5394
Mailing Address - Fax:
Practice Address - Street 1:409 BELL RD S
Practice Address - Street 2:
Practice Address - City:ROME
Practice Address - State:NY
Practice Address - Zip Code:13440-3864
Practice Address - Country:US
Practice Address - Phone:315-338-6500
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2013-06-10
Last Update Date:2013-06-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY631567-1163WS0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163WS0200XNursing Service ProvidersRegistered NurseSchool