Provider Demographics
NPI:1104176775
Name:LASECKI, ELIZABETH (LPN)
Entity type:Individual
Prefix:
First Name:ELIZABETH
Middle Name:
Last Name:LASECKI
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 1:5229 CABLE HOLLOW RD
Mailing Address - Street 2:
Mailing Address - City:RUSSEL
Mailing Address - State:PA
Mailing Address - Zip Code:16345
Mailing Address - Country:US
Mailing Address - Phone:181-475-7937
Mailing Address - Fax:
Practice Address - Street 1:1680 WALDEN AVE
Practice Address - Street 2:
Practice Address - City:CHEEKTOWAGA
Practice Address - State:NY
Practice Address - Zip Code:14225-4914
Practice Address - Country:US
Practice Address - Phone:716-894-7777
Practice Address - Fax:716-894-0604
Is Sole Proprietor?:No
Enumeration Date:2012-09-11
Last Update Date:2012-09-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY308531164W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes164W00000XNursing Service ProvidersLicensed Practical Nurse