Provider Demographics
NPI:1841339223
Name:GIACCONE, LAVERNE LIZA (BSN MA NCSN)
Entity type:Individual
Prefix:MRS
First Name:LAVERNE
Middle Name:LIZA
Last Name:GIACCONE
Suffix:
Gender:F
Credentials:BSN MA NCSN
Other - Prefix:
Other - First Name:LIZA
Other - Middle Name:P
Other - Last Name:GIACCONE
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:
Mailing Address - Street 1:181 RIDGEWOOD DRIVE
Mailing Address - Street 2:
Mailing Address - City:CAMDEN WYOMING
Mailing Address - State:DE
Mailing Address - Zip Code:19934
Mailing Address - Country:US
Mailing Address - Phone:302-698-1019
Mailing Address - Fax:
Practice Address - Street 1:1 PAT LYNN DRIVE
Practice Address - Street 2:DOVER HIGH SCHOOL
Practice Address - City:DOVER
Practice Address - State:DE
Practice Address - Zip Code:19904
Practice Address - Country:US
Practice Address - Phone:302-672-1535
Practice Address - Fax:302-672-1565
Is Sole Proprietor?:No
Enumeration Date:2007-02-05
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
DEL10011864163WS0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163WS0200XNursing Service ProvidersRegistered NurseSchool