Provider Demographics
NPI:1124286455
Name:MEAD, DARLENE A (RN)
Entity type:Individual
Prefix:
First Name:DARLENE
Middle Name:A
Last Name:MEAD
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 1:19 BENTLEY CIR
Mailing Address - Street 2:
Mailing Address - City:LANCASTER
Mailing Address - State:NY
Mailing Address - Zip Code:14086-9329
Mailing Address - Country:US
Mailing Address - Phone:716-683-3471
Mailing Address - Fax:
Practice Address - Street 1:19 BENTLEY CIR
Practice Address - Street 2:
Practice Address - City:LANCASTER
Practice Address - State:NY
Practice Address - Zip Code:14086-9329
Practice Address - Country:US
Practice Address - Phone:716-683-3471
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2008-05-22
Last Update Date:2021-01-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY450501-1163W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163W00000XNursing Service ProvidersRegistered Nurse
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY02750190Medicaid