Provider Demographics
NPI:1154952893
Name:SEDORE, NANNETTE (LPN)
Entity type:Individual
Prefix:
First Name:NANNETTE
Middle Name:
Last Name:SEDORE
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 1:1150 COUNTY ROUTE 60
Mailing Address - Street 2:
Mailing Address - City:ELMIRA
Mailing Address - State:NY
Mailing Address - Zip Code:14901-9438
Mailing Address - Country:US
Mailing Address - Phone:785-342-8068
Mailing Address - Fax:
Practice Address - Street 1:1000 BROADWAY ST
Practice Address - Street 2:
Practice Address - City:ELMIRA
Practice Address - State:NY
Practice Address - Zip Code:14904-2502
Practice Address - Country:US
Practice Address - Phone:607-735-3300
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-01-31
Last Update Date:2020-01-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY333128-1164W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes164W00000XNursing Service ProvidersLicensed Practical Nurse