Provider Demographics
NPI:1952951725
Name:BESEMER, LOTUS J (LPN)
Entity Type:Individual
Prefix:
First Name:LOTUS
Middle Name:J
Last Name:BESEMER
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 1:6 BLACKBURN KNL
Mailing Address - Street 2:
Mailing Address - City:SPENCERPORT
Mailing Address - State:NY
Mailing Address - Zip Code:14559-2199
Mailing Address - Country:US
Mailing Address - Phone:585-478-9687
Mailing Address - Fax:
Practice Address - Street 1:6 BLACKBURN KNL
Practice Address - Street 2:
Practice Address - City:SPENCERPORT
Practice Address - State:NY
Practice Address - Zip Code:14559-2199
Practice Address - Country:US
Practice Address - Phone:585-478-9687
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2019-09-13
Last Update Date:2019-09-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY326192-1164W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes164W00000XNursing Service ProvidersLicensed Practical NurseGroup - Single Specialty