Provider Demographics
NPI:1457618233
Name:LAMOUR-PELISSIER, BERTH
Entity Type:Individual
Prefix:
First Name:BERTH
Middle Name:
Last Name:LAMOUR-PELISSIER
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:835 DAVID CT
Mailing Address - Street 2:
Mailing Address - City:UNIONDALE
Mailing Address - State:NY
Mailing Address - Zip Code:11553-3433
Mailing Address - Country:US
Mailing Address - Phone:516-481-0752
Mailing Address - Fax:
Practice Address - Street 1:835 DAVID CT
Practice Address - Street 2:
Practice Address - City:UNIONDALE
Practice Address - State:NY
Practice Address - Zip Code:11553-3433
Practice Address - Country:US
Practice Address - Phone:516-481-0752
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2012-04-18
Last Update Date:2012-04-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY308781164W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes164W00000XNursing Service ProvidersLicensed Practical Nurse