Provider Demographics
NPI:1518018050
Name:PINE, LUCRITIA ROBINSON (RN)
Entity Type:Individual
Prefix:MS
First Name:LUCRITIA
Middle Name:ROBINSON
Last Name:PINE
Suffix:
Gender:F
Credentials:RN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:277 STEWARTS CORNERS RD
Mailing Address - Street 2:
Mailing Address - City:PENNELLVILLE
Mailing Address - State:NY
Mailing Address - Zip Code:13132-3290
Mailing Address - Country:US
Mailing Address - Phone:315-695-3798
Mailing Address - Fax:
Practice Address - Street 1:277 STEWARTS CORNERS RD
Practice Address - Street 2:
Practice Address - City:PENNELLVILLE
Practice Address - State:NY
Practice Address - Zip Code:13132-3290
Practice Address - Country:US
Practice Address - Phone:315-695-3798
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-01-12
Last Update Date:2007-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY278292-1163WH0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163WH0200XNursing Service ProvidersRegistered NurseHome Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY02704878Medicaid