Provider Demographics
NPI:1619472636
Name:LICAK, LINDSEY MORGAN (RN)
Entity Type:Individual
Prefix:MRS
First Name:LINDSEY
Middle Name:MORGAN
Last Name:LICAK
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 1:1986 GILBERT RD
Mailing Address - Street 2:
Mailing Address - City:OVID
Mailing Address - State:NY
Mailing Address - Zip Code:14521-9762
Mailing Address - Country:US
Mailing Address - Phone:607-765-1280
Mailing Address - Fax:
Practice Address - Street 1:1986 GILBERT RD
Practice Address - Street 2:
Practice Address - City:OVID
Practice Address - State:NY
Practice Address - Zip Code:14521-9762
Practice Address - Country:US
Practice Address - Phone:607-765-1280
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-03-30
Last Update Date:2018-03-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY738490163W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163W00000XNursing Service ProvidersRegistered Nurse