Provider Demographics
NPI:1669617353
Name:BARANKOVICH, STEPHANIE JEAN (LPN)
Entity type:Individual
Prefix:
First Name:STEPHANIE
Middle Name:JEAN
Last Name:BARANKOVICH
Suffix:
Gender:F
Credentials:LPN
Other - Prefix:
Other - First Name:STEPHANIE
Other - Middle Name:JEAN
Other - Last Name:RENNIE
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:LPN
Mailing Address - Street 1:102 BLUMER RD
Mailing Address - Street 2:
Mailing Address - City:PENNELLVILLE
Mailing Address - State:NY
Mailing Address - Zip Code:13132-3252
Mailing Address - Country:US
Mailing Address - Phone:315-668-1747
Mailing Address - Fax:
Practice Address - Street 1:102 BLUMER RD
Practice Address - Street 2:
Practice Address - City:PENNELLVILLE
Practice Address - State:NY
Practice Address - Zip Code:13132-3252
Practice Address - Country:US
Practice Address - Phone:315-668-1747
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2008-12-09
Last Update Date:2010-02-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY227215164W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes164W00000XNursing Service ProvidersLicensed Practical Nurse