Provider Demographics
NPI:1356522213
Name:NOLL, VERONICA NEPOMUCENO (LPN)
Entity type:Individual
Prefix:
First Name:VERONICA
Middle Name:NEPOMUCENO
Last Name:NOLL
Suffix:
Gender:F
Credentials:LPN
Other - Prefix:MISS
Other - First Name:VERONICA
Other - Middle Name:KIUNISALA
Other - Last Name:NEPOMUCENO
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:LPN
Mailing Address - Street 1:122 LAWRENCE ST
Mailing Address - Street 2:
Mailing Address - City:SYRACUSE
Mailing Address - State:NY
Mailing Address - Zip Code:13208-2144
Mailing Address - Country:US
Mailing Address - Phone:315-422-4641
Mailing Address - Fax:
Practice Address - Street 1:122 LAWRENCE ST
Practice Address - Street 2:
Practice Address - City:SYRACUSE
Practice Address - State:NY
Practice Address - Zip Code:13208-2144
Practice Address - Country:US
Practice Address - Phone:315-422-4641
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-11-20
Last Update Date:2007-11-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY281446164W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes164W00000XNursing Service ProvidersLicensed Practical Nurse