Provider Demographics
NPI:1811040660
Name:DEVEREAUX, LISA ANN (LPN)
Entity Type:Individual
Prefix:MS
First Name:LISA
Middle Name:ANN
Last Name:DEVEREAUX
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 1:1001 ELEVENTH STREET
Mailing Address - Street 2:ROOM 172 TROTT ACCESS CENTER
Mailing Address - City:NIAGARA FALLS
Mailing Address - State:NY
Mailing Address - Zip Code:14301
Mailing Address - Country:US
Mailing Address - Phone:716-278-8110
Mailing Address - Fax:716-278-8111
Practice Address - Street 1:1001 ELEVENTH STREET
Practice Address - Street 2:ROOM 172 TROTT ACCESS CENTER
Practice Address - City:NIAGARA FALLS
Practice Address - State:NY
Practice Address - Zip Code:14301
Practice Address - Country:US
Practice Address - Phone:716-278-8110
Practice Address - Fax:716-278-8111
Is Sole Proprietor?:No
Enumeration Date:2007-01-18
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY2249301164W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes164W00000XNursing Service ProvidersLicensed Practical Nurse