Provider Demographics
NPI:1790347383
Name:DEFALCO, EUNICE I (LPN)
Entity Type:Individual
Prefix:
First Name:EUNICE
Middle Name:I
Last Name:DEFALCO
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:PO BOX 123
Mailing Address - Street 2:
Mailing Address - City:DOWNSVILLE
Mailing Address - State:NY
Mailing Address - Zip Code:13755-0123
Mailing Address - Country:US
Mailing Address - Phone:607-386-9084
Mailing Address - Fax:
Practice Address - Street 1:426 E RIVER RD
Practice Address - Street 2:
Practice Address - City:WALTON
Practice Address - State:NY
Practice Address - Zip Code:13856-2106
Practice Address - Country:US
Practice Address - Phone:607-386-9084
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2019-07-03
Last Update Date:2019-07-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY296924-1164W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes164W00000XNursing Service ProvidersLicensed Practical Nurse