Provider Demographics
NPI:1215771522
Name:CHANEY, MIA (LPN)
Entity type:Individual
Prefix:
First Name:MIA
Middle Name:
Last Name:CHANEY
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 1:33 MONTROSE AVE
Mailing Address - Street 2:
Mailing Address - City:BUFFALO
Mailing Address - State:NY
Mailing Address - Zip Code:14214-1238
Mailing Address - Country:US
Mailing Address - Phone:646-623-9707
Mailing Address - Fax:
Practice Address - Street 1:500 SENECA ST STE 610
Practice Address - Street 2:
Practice Address - City:BUFFALO
Practice Address - State:NY
Practice Address - Zip Code:14204-1963
Practice Address - Country:US
Practice Address - Phone:716-881-2100
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-06-21
Last Update Date:2024-10-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY350331-01164W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes164W00000XNursing Service ProvidersLicensed Practical Nurse