Provider Demographics
NPI:1780858514
Name:FOX, LISA MARIE (LPN)
Entity Type:Individual
Prefix:MRS
First Name:LISA
Middle Name:MARIE
Last Name:FOX
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 1:1248 COUNTY ROAD 6
Mailing Address - Street 2:
Mailing Address - City:PHELPS
Mailing Address - State:NY
Mailing Address - Zip Code:14532-9521
Mailing Address - Country:US
Mailing Address - Phone:315-548-4408
Mailing Address - Fax:
Practice Address - Street 1:1248 COUNTY ROAD 6
Practice Address - Street 2:
Practice Address - City:PHELPS
Practice Address - State:NY
Practice Address - Zip Code:14532-9521
Practice Address - Country:US
Practice Address - Phone:315-548-4408
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2008-04-14
Last Update Date:2008-04-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY217974164W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes164W00000XNursing Service ProvidersLicensed Practical Nurse