Provider Demographics
NPI:1306464094
Name:LINCOLN, DORIS JEAN (LPN)
Entity type:Individual
Prefix:
First Name:DORIS
Middle Name:JEAN
Last Name:LINCOLN
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 1:1857 WILLOW AVE
Mailing Address - Street 2:
Mailing Address - City:NIAGARA FALLS
Mailing Address - State:NY
Mailing Address - Zip Code:14305-3049
Mailing Address - Country:US
Mailing Address - Phone:716-990-4940
Mailing Address - Fax:
Practice Address - Street 1:1857 WILLOW AVE
Practice Address - Street 2:
Practice Address - City:NIAGARA FALLS
Practice Address - State:NY
Practice Address - Zip Code:14305-3049
Practice Address - Country:US
Practice Address - Phone:716-990-4940
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-07-08
Last Update Date:2020-10-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY336964-01164W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes164W00000XNursing Service ProvidersLicensed Practical NurseGroup - Single Specialty