Provider Demographics
NPI:1740773118
Name:LOBIANCO, ALISSA ROSE (BSN, RN)
Entity type:Individual
Prefix:MRS
First Name:ALISSA
Middle Name:ROSE
Last Name:LOBIANCO
Suffix:
Gender:F
Credentials:BSN, RN
Other - Prefix:
Other - First Name:ALISSA
Other - Middle Name:ROSE
Other - Last Name:BETANCOURT
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:LPN
Mailing Address - Street 1:633 OLD COUNTRY ROAD
Mailing Address - Street 2:
Mailing Address - City:RIVERHEAD
Mailing Address - State:NY
Mailing Address - Zip Code:11901
Mailing Address - Country:US
Mailing Address - Phone:631-872-9849
Mailing Address - Fax:
Practice Address - Street 1:633 OLD COUNTRY ROAD
Practice Address - Street 2:
Practice Address - City:RIVERHEAD
Practice Address - State:NY
Practice Address - Zip Code:11901
Practice Address - Country:US
Practice Address - Phone:631-872-9849
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2018-06-11
Last Update Date:2024-06-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY786930164W00000X, 163W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163W00000XNursing Service ProvidersRegistered Nurse
No164W00000XNursing Service ProvidersLicensed Practical Nurse