1497193619 NPI number — MRS. LANETTE ANN OTTALAGANO VINCI R.N.

Table of content: MRS. LANETTE ANN OTTALAGANO VINCI R.N. (NPI 1497193619)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1497193619 NPI number — MRS. LANETTE ANN OTTALAGANO VINCI R.N.

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
OTTALAGANO VINCI
Provider First Name:
LANETTE
Provider Middle Name:
ANN
Provider Name Prefix Text:
MRS.
Provider Name Suffix Text:
Provider Credential Text:
R.N.
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
OTTALAGANO
Provider Other First Name:
LANETTE
Provider Other Middle Name:
ANN
Provider Other Name Prefix Text:
MISS
Provider Other Name Suffix Text:
Provider Other Credential Text:
R.N.
Provider Other Last Name Type Code:
1

NPI Number Information

NPI Number:
1497193619
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
06/10/2013
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
14 SELDEN DR
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
ROME
Provider Business Mailing Address State Name:
NY
Provider Business Mailing Address Postal Code:
13440-0901
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
315-533-5394
Provider Business Mailing Address Fax Number:

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
409 BELL RD S
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
ROME
Provider Business Practice Location Address State Name:
NY
Provider Business Practice Location Address Postal Code:
13440-3864
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
315-338-6500
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
06/10/2013

Additional Information

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 163WS0200X , with the licence number:  631567-1 , registered in the state of NY ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)





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