Provider Demographics
NPI:1952749350
Name:MEZYDLO, NANCY RICE (LPN)
Entity Type:Individual
Prefix:
First Name:NANCY
Middle Name:RICE
Last Name:MEZYDLO
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 1:1560 FRENCH RD
Mailing Address - Street 2:1560 FRENCH ROAD
Mailing Address - City:ATTICA
Mailing Address - State:NY
Mailing Address - Zip Code:14011-9531
Mailing Address - Country:US
Mailing Address - Phone:585-591-0551
Mailing Address - Fax:
Practice Address - Street 1:1560 FRENCH RD
Practice Address - Street 2:1560 FRENCH ROAD
Practice Address - City:ATTICA
Practice Address - State:NY
Practice Address - Zip Code:14011-9531
Practice Address - Country:US
Practice Address - Phone:585-591-0551
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2013-06-06
Last Update Date:2013-06-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY205235-1164W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes164W00000XNursing Service ProvidersLicensed Practical Nurse
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY01199100Medicaid