Provider Demographics
NPI:1578607123
Name:LANCIAULT, ELIZABETH ANN (LPN)
Entity Type:Individual
Prefix:
First Name:ELIZABETH
Middle Name:ANN
Last Name:LANCIAULT
Suffix:
Gender:F
Credentials:LPN
Other - Prefix:
Other - First Name:ELIZABETH
Other - Middle Name:ANN
Other - Last Name:TRIPP-OLSON
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:LPN
Mailing Address - Street 1:125 MERCHANT ST
Mailing Address - Street 2:
Mailing Address - City:GUILFORD
Mailing Address - State:NY
Mailing Address - Zip Code:13780-3190
Mailing Address - Country:US
Mailing Address - Phone:607-895-6513
Mailing Address - Fax:607-895-6954
Practice Address - Street 1:1576 STATE HIGHWAY 41
Practice Address - Street 2:
Practice Address - City:AFTON
Practice Address - State:NY
Practice Address - Zip Code:13730-3125
Practice Address - Country:US
Practice Address - Phone:607-639-5551
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-02-16
Last Update Date:2008-08-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY242808-1164W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes164W00000XNursing Service ProvidersLicensed Practical Nurse