Healthcare Provider Details

I. General information

NPI: 1487979191
Provider Name (Legal Business Name): LANEICE ALLEN
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 04/06/2010
Last Update Date: 04/06/2010
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

426 FRANKLIN ST
SCHENECTADY NY
12305-2040
US

IV. Provider business mailing address

2321 16TH ST
TROY NY
12180-2308
US

V. Phone/Fax

Practice location:
  • Phone: 518-374-3403
  • Fax: 518-374-3482
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code164W00000X
TaxonomyLicensed Practical Nurse
License Number276315
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: