Provider Demographics
NPI:1750558748
Name:WILLIFORD, LISA V (LPN)
Entity type:Individual
Prefix:MS
First Name:LISA
Middle Name:V
Last Name:WILLIFORD
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 1:653 BEACH 67TH ST
Mailing Address - Street 2:
Mailing Address - City:ARVERNE
Mailing Address - State:NY
Mailing Address - Zip Code:11692-1312
Mailing Address - Country:US
Mailing Address - Phone:718-474-3207
Mailing Address - Fax:
Practice Address - Street 1:653 BEACH 67TH ST
Practice Address - Street 2:
Practice Address - City:ARVERNE
Practice Address - State:NY
Practice Address - Zip Code:11692-1312
Practice Address - Country:US
Practice Address - Phone:718-474-3207
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2008-05-09
Last Update Date:2008-05-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY10 249357164W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes164W00000XNursing Service ProvidersLicensed Practical Nurse