Provider Demographics
NPI:1861634578
Name:BURNETT, ALESE NICOLE (LPN)
Entity Type:Individual
Prefix:
First Name:ALESE
Middle Name:NICOLE
Last Name:BURNETT
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 1:207 W ROSWELL AVE
Mailing Address - Street 2:
Mailing Address - City:NEDROW
Mailing Address - State:NY
Mailing Address - Zip Code:13120-1030
Mailing Address - Country:US
Mailing Address - Phone:315-469-6095
Mailing Address - Fax:
Practice Address - Street 1:207 W ROSWELL AVE
Practice Address - Street 2:
Practice Address - City:NEDROW
Practice Address - State:NY
Practice Address - Zip Code:13120-1030
Practice Address - Country:US
Practice Address - Phone:315-469-6095
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2009-03-26
Last Update Date:2009-03-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY290183164W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes164W00000XNursing Service ProvidersLicensed Practical Nurse