Provider Demographics
NPI:1295182723
Name:SWEENEY, JOANNA (LPN)
Entity type:Individual
Prefix:
First Name:JOANNA
Middle Name:
Last Name:SWEENEY
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 1:807 SYMONDS PL
Mailing Address - Street 2:
Mailing Address - City:UTICA
Mailing Address - State:NY
Mailing Address - Zip Code:13502-5619
Mailing Address - Country:US
Mailing Address - Phone:315-868-4652
Mailing Address - Fax:
Practice Address - Street 1:6050 CAVANAUGH RD
Practice Address - Street 2:
Practice Address - City:MARCY
Practice Address - State:NY
Practice Address - Zip Code:13403-2411
Practice Address - Country:US
Practice Address - Phone:315-534-0730
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2016-05-13
Last Update Date:2016-05-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY293791-1164W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes164W00000XNursing Service ProvidersLicensed Practical Nurse