Provider Demographics
NPI:1922357094
Name:LESPERANCE, MARY LOU (LPN)
Entity Type:Individual
Prefix:MS
First Name:MARY
Middle Name:LOU
Last Name:LESPERANCE
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 1:125 FINNEY BLVD
Mailing Address - Street 2:
Mailing Address - City:MALONE
Mailing Address - State:NY
Mailing Address - Zip Code:12953-1067
Mailing Address - Country:US
Mailing Address - Phone:518-481-8160
Mailing Address - Fax:518-481-8161
Practice Address - Street 1:125 FINNEY BLVD
Practice Address - Street 2:
Practice Address - City:MALONE
Practice Address - State:NY
Practice Address - Zip Code:12953-1067
Practice Address - Country:US
Practice Address - Phone:518-481-8160
Practice Address - Fax:518-481-8161
Is Sole Proprietor?:Yes
Enumeration Date:2012-09-05
Last Update Date:2023-12-15
Deactivation Date:2023-11-29
Deactivation Code:
Reactivation Date:2023-12-05
Provider Licenses
StateLicense IDTaxonomies
NY265294164W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes164W00000XNursing Service ProvidersLicensed Practical Nurse
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY265294OtherLICENSED PRACTICAL NURSE