Provider Demographics
NPI:1720276165
Name:ADINDU, LIGHT A (LPN)
Entity Type:Individual
Prefix:MR
First Name:LIGHT
Middle Name:A
Last Name:ADINDU
Suffix:
Gender:M
Credentials:LPN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:62 MOUNT EFFORT DR
Mailing Address - Street 2:
Mailing Address - City:EFFORT
Mailing Address - State:PA
Mailing Address - Zip Code:18330-9434
Mailing Address - Country:US
Mailing Address - Phone:570-350-6870
Mailing Address - Fax:570-629-9505
Practice Address - Street 1:62 MOUNT EFFORT DR
Practice Address - Street 2:
Practice Address - City:EFFORT
Practice Address - State:PA
Practice Address - Zip Code:18330-9434
Practice Address - Country:US
Practice Address - Phone:570-350-6870
Practice Address - Fax:570-629-9505
Is Sole Proprietor?:Yes
Enumeration Date:2007-10-10
Last Update Date:2007-10-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY254046-1164W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes164W00000XNursing Service ProvidersLicensed Practical Nurse