Provider Demographics
NPI:1760041370
Name:DISARNO, RALPH ANTHONY (LPN)
Entity Type:Individual
Prefix:
First Name:RALPH
Middle Name:ANTHONY
Last Name:DISARNO
Suffix:
Gender:M
Credentials:LPN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:148 KODY LN
Mailing Address - Street 2:
Mailing Address - City:DELEVAN
Mailing Address - State:NY
Mailing Address - Zip Code:14042-9523
Mailing Address - Country:US
Mailing Address - Phone:716-258-1292
Mailing Address - Fax:
Practice Address - Street 1:148 KODY LN
Practice Address - Street 2:
Practice Address - City:DELEVAN
Practice Address - State:NY
Practice Address - Zip Code:14042-9523
Practice Address - Country:US
Practice Address - Phone:716-258-1292
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2019-06-07
Last Update Date:2019-06-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY301253164W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes164W00000XNursing Service ProvidersLicensed Practical Nurse