Provider Demographics
NPI:1386998284
Name:FAY, LIANNNE (RN)
Entity type:Individual
Prefix:
First Name:LIANNNE
Middle Name:
Last Name:FAY
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 1:84 CORNING AVE
Mailing Address - Street 2:
Mailing Address - City:WORCESTER
Mailing Address - State:MA
Mailing Address - Zip Code:01605-1434
Mailing Address - Country:US
Mailing Address - Phone:508-826-9604
Mailing Address - Fax:
Practice Address - Street 1:84 CORNING AVE
Practice Address - Street 2:
Practice Address - City:WORCESTER
Practice Address - State:MA
Practice Address - Zip Code:01605-1434
Practice Address - Country:US
Practice Address - Phone:508-826-9604
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2012-10-31
Last Update Date:2012-10-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA2281804163W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163W00000XNursing Service ProvidersRegistered Nurse