Provider Demographics
NPI:1154578359
Name:MAIONE, KIMBERLY LYNN ANN (LPN)
Entity type:Individual
Prefix:
First Name:KIMBERLY
Middle Name:LYNN ANN
Last Name:MAIONE
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 1:39 OAKWOOD DR
Mailing Address - Street 2:
Mailing Address - City:SHIRLEY
Mailing Address - State:NY
Mailing Address - Zip Code:11967-3925
Mailing Address - Country:US
Mailing Address - Phone:631-949-2072
Mailing Address - Fax:
Practice Address - Street 1:39 OAKWOOD DR
Practice Address - Street 2:
Practice Address - City:SHIRLEY
Practice Address - State:NY
Practice Address - Zip Code:11967-3925
Practice Address - Country:US
Practice Address - Phone:631-949-2072
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2008-08-19
Last Update Date:2008-08-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY262787-1164W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes164W00000XNursing Service ProvidersLicensed Practical Nurse