Provider Demographics
NPI:1023295565
Name:LAVENTURE, ANGELA JEAN (LPN)
Entity type:Individual
Prefix:MRS
First Name:ANGELA
Middle Name:JEAN
Last Name:LAVENTURE
Suffix:
Gender:F
Credentials:LPN
Other - Prefix:MS
Other - First Name:ANGELA
Other - Middle Name:JEAN
Other - Last Name:GIARDENELLI
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:331 TERRACE ROAD
Mailing Address - Street 2:
Mailing Address - City:SCHENECTADY
Mailing Address - State:NY
Mailing Address - Zip Code:12306
Mailing Address - Country:US
Mailing Address - Phone:518-382-1644
Mailing Address - Fax:
Practice Address - Street 1:6270 FOUNDRY ROAD
Practice Address - Street 2:
Practice Address - City:GUILDERLAND
Practice Address - State:NY
Practice Address - Zip Code:12084
Practice Address - Country:US
Practice Address - Phone:518-452-1270
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2008-01-28
Last Update Date:2008-01-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY274965164W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes164W00000XNursing Service ProvidersLicensed Practical Nurse
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY02501417Medicaid