Provider Demographics
NPI:1215130471
Name:JONES, LAINIE JEAN (LIC PRACTICAL NURSE)
Entity type:Individual
Prefix:MRS
First Name:LAINIE
Middle Name:JEAN
Last Name:JONES
Suffix:
Gender:F
Credentials:LIC PRACTICAL NURSE
Other - Prefix:
Other - First Name:LAINIE
Other - Middle Name:
Other - Last Name:SPENCER
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:112 WOODSIDE AVE
Mailing Address - Street 2:APT 1
Mailing Address - City:BUFFALO
Mailing Address - State:NY
Mailing Address - Zip Code:14220
Mailing Address - Country:US
Mailing Address - Phone:716-824-0514
Mailing Address - Fax:
Practice Address - Street 1:6856 SOUTHWESTERN BLVD
Practice Address - Street 2:
Practice Address - City:LAKEVIEW
Practice Address - State:NY
Practice Address - Zip Code:14085
Practice Address - Country:US
Practice Address - Phone:716-627-5970
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-06-06
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY2757121164W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes164W00000XNursing Service ProvidersLicensed Practical Nurse
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY02823398Medicaid