Provider Demographics
NPI:1508228586
Name:LAMPASONA, DAWN PESCATORE
Entity Type:Individual
Prefix:
First Name:DAWN
Middle Name:PESCATORE
Last Name:LAMPASONA
Suffix:
Gender:F
Credentials:
Other - Prefix:MS
Other - First Name:DAWN
Other - Middle Name:
Other - Last Name:LAMPASONA
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:LPN
Mailing Address - Street 1:PO BOX 545
Mailing Address - Street 2:
Mailing Address - City:GLEN COVE
Mailing Address - State:NY
Mailing Address - Zip Code:11542-0545
Mailing Address - Country:US
Mailing Address - Phone:516-375-6950
Mailing Address - Fax:
Practice Address - Street 1:315 W BROADWAY APT 1K
Practice Address - Street 2:
Practice Address - City:LONG BEACH
Practice Address - State:NY
Practice Address - Zip Code:11561-3953
Practice Address - Country:US
Practice Address - Phone:516-375-6950
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2016-03-28
Last Update Date:2016-03-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY186525-1164W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes164W00000XNursing Service ProvidersLicensed Practical Nurse