Provider Demographics
NPI:1154758357
Name:LESPERANCE, MARY ANNE (RN)
Entity type:Individual
Prefix:MRS
First Name:MARY ANNE
Middle Name:
Last Name:LESPERANCE
Suffix:
Gender:F
Credentials:RN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4340 WETZEL RD
Mailing Address - Street 2:
Mailing Address - City:LIVERPOOL
Mailing Address - State:NY
Mailing Address - Zip Code:13090-2029
Mailing Address - Country:US
Mailing Address - Phone:315-453-1276
Mailing Address - Fax:315-453-1247
Practice Address - Street 1:4340 WETZEL RD
Practice Address - Street 2:
Practice Address - City:LIVERPOOL
Practice Address - State:NY
Practice Address - Zip Code:13090-2029
Practice Address - Country:US
Practice Address - Phone:315-453-1276
Practice Address - Fax:315-453-1247
Is Sole Proprietor?:Yes
Enumeration Date:2013-10-02
Last Update Date:2013-10-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY591568-1163W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163W00000XNursing Service ProvidersRegistered Nurse