Provider Demographics
NPI:1134360613
Name:LABANCA, LINDA SUSAN (NURSE PRACTITIONER)
Entity type:Individual
Prefix:MS
First Name:LINDA
Middle Name:SUSAN
Last Name:LABANCA
Suffix:
Gender:F
Credentials:NURSE PRACTITIONER
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:931 SIPP AVE
Mailing Address - Street 2:
Mailing Address - City:EAST PATCHOGUE
Mailing Address - State:NY
Mailing Address - Zip Code:11772
Mailing Address - Country:US
Mailing Address - Phone:919-413-2951
Mailing Address - Fax:919-516-4195
Practice Address - Street 1:931 SIPP AVE
Practice Address - Street 2:
Practice Address - City:EAST PATCHOGUE
Practice Address - State:NY
Practice Address - Zip Code:11772
Practice Address - Country:US
Practice Address - Phone:919-413-2951
Practice Address - Fax:919-516-4195
Is Sole Proprietor?:No
Enumeration Date:2009-03-13
Last Update Date:2012-12-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC5004161363LF0000X
NYF330289363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily