Provider Demographics
NPI:1952753550
Name:LAMANNA, REBECCA (PNP)
Entity type:Individual
Prefix:
First Name:REBECCA
Middle Name:
Last Name:LAMANNA
Suffix:
Gender:F
Credentials:PNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:711 TROY SCHENECTADY RD
Mailing Address - Street 2:SUITE 201
Mailing Address - City:LATHAM
Mailing Address - State:NY
Mailing Address - Zip Code:12110-2442
Mailing Address - Country:US
Mailing Address - Phone:518-782-3700
Mailing Address - Fax:518-782-3799
Practice Address - Street 1:1184 STATE ROUTE 50
Practice Address - Street 2:
Practice Address - City:BALLSTON LAKE
Practice Address - State:NY
Practice Address - Zip Code:12019-1923
Practice Address - Country:US
Practice Address - Phone:518-384-1281
Practice Address - Fax:518-384-0321
Is Sole Proprietor?:No
Enumeration Date:2016-07-07
Last Update Date:2016-12-27
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
NY382647363LP0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP0200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPediatrics
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY04474677Medicaid
NYJ400322549Medicare PIN