Provider Demographics
NPI:1669954020
Name:PANESA, LAUREN BRITTANY (LPN)
Entity type:Individual
Prefix:MRS
First Name:LAUREN
Middle Name:BRITTANY
Last Name:PANESA
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 1:216 BAKER ROAD
Mailing Address - Street 2:
Mailing Address - City:WEST HURLEY
Mailing Address - State:NY
Mailing Address - Zip Code:12491
Mailing Address - Country:US
Mailing Address - Phone:845-853-2362
Mailing Address - Fax:
Practice Address - Street 1:216 BAKER ROAD
Practice Address - Street 2:
Practice Address - City:WEST HURLEY
Practice Address - State:NY
Practice Address - Zip Code:12491
Practice Address - Country:US
Practice Address - Phone:845-853-2362
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2018-09-02
Last Update Date:2018-09-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY323065164W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes164W00000XNursing Service ProvidersLicensed Practical Nurse