Provider Demographics
NPI:1154600385
Name:LOMANTO, LEEANN
Entity type:Individual
Prefix:
First Name:LEEANN
Middle Name:
Last Name:LOMANTO
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 118
Mailing Address - Street 2:
Mailing Address - City:SOUTH JAMESPORT
Mailing Address - State:NY
Mailing Address - Zip Code:11970-0118
Mailing Address - Country:US
Mailing Address - Phone:631-422-4363
Mailing Address - Fax:
Practice Address - Street 1:779 MANOR LANE
Practice Address - Street 2:
Practice Address - City:RIVERHEAD
Practice Address - State:NY
Practice Address - Zip Code:11901
Practice Address - Country:US
Practice Address - Phone:631-422-4363
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2011-08-05
Last Update Date:2011-08-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY509990163W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163W00000XNursing Service ProvidersRegistered Nurse