Provider Demographics
NPI:1689084618
Name:FACOMPRE, MARY-ANNE (LPN)
Entity Type:Individual
Prefix:
First Name:MARY-ANNE
Middle Name:
Last Name:FACOMPRE
Suffix:
Gender:F
Credentials:LPN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:31 SHERYL CRES
Mailing Address - Street 2:
Mailing Address - City:SMITHTOWN
Mailing Address - State:NY
Mailing Address - Zip Code:11787-1321
Mailing Address - Country:US
Mailing Address - Phone:631-834-1898
Mailing Address - Fax:
Practice Address - Street 1:31 SHERYL CRES
Practice Address - Street 2:
Practice Address - City:SMITHTOWN
Practice Address - State:NY
Practice Address - Zip Code:11787-1321
Practice Address - Country:US
Practice Address - Phone:631-834-1898
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2014-04-29
Last Update Date:2014-04-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY314808-1164W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes164W00000XNursing Service ProvidersLicensed Practical Nurse