Provider Demographics
NPI:1851617260
Name:THEOFIELD, ALANE JOYCE (RN)
Entity Type:Individual
Prefix:
First Name:ALANE
Middle Name:JOYCE
Last Name:THEOFIELD
Suffix:
Gender:F
Credentials:RN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:28 HANOVER PL
Mailing Address - Street 2:
Mailing Address - City:SMITHTOWN
Mailing Address - State:NY
Mailing Address - Zip Code:11787-3407
Mailing Address - Country:US
Mailing Address - Phone:631-724-6167
Mailing Address - Fax:
Practice Address - Street 1:28 HANOVER PL
Practice Address - Street 2:
Practice Address - City:SMITHTOWN
Practice Address - State:NY
Practice Address - Zip Code:11787-3407
Practice Address - Country:US
Practice Address - Phone:631-724-6167
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2010-04-09
Last Update Date:2010-04-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY382058-1163W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163W00000XNursing Service ProvidersRegistered Nurse
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY382058-1Medicaid