Provider Demographics
NPI:1952794265
Name:LENNON, ELLEN (RN)
Entity Type:Individual
Prefix:
First Name:ELLEN
Middle Name:
Last Name:LENNON
Suffix:
Gender:F
Credentials:RN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4 WEST ST
Mailing Address - Street 2:
Mailing Address - City:MACEDON
Mailing Address - State:NY
Mailing Address - Zip Code:14502-8803
Mailing Address - Country:US
Mailing Address - Phone:315-986-2080
Mailing Address - Fax:
Practice Address - Street 1:4 WEST ST
Practice Address - Street 2:
Practice Address - City:MACEDON
Practice Address - State:NY
Practice Address - Zip Code:14502-8803
Practice Address - Country:US
Practice Address - Phone:315-986-2080
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2015-03-11
Last Update Date:2015-03-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY535562163W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163W00000XNursing Service ProvidersRegistered Nurse