Provider Demographics
NPI:1427506005
Name:PERSICHILLI, THERESA (LPN)
Entity type:Individual
Prefix:MRS
First Name:THERESA
Middle Name:
Last Name:PERSICHILLI
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 1:134 SENECA ST
Mailing Address - Street 2:
Mailing Address - City:HORNELL
Mailing Address - State:NY
Mailing Address - Zip Code:14843-1324
Mailing Address - Country:US
Mailing Address - Phone:607-324-1303
Mailing Address - Fax:607-324-5325
Practice Address - Street 1:134 SENECA ST
Practice Address - Street 2:
Practice Address - City:HORNELL
Practice Address - State:NY
Practice Address - Zip Code:14843-1324
Practice Address - Country:US
Practice Address - Phone:607-324-1303
Practice Address - Fax:607-324-5325
Is Sole Proprietor?:Yes
Enumeration Date:2016-09-13
Last Update Date:2016-09-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY148340-1164W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes164W00000XNursing Service ProvidersLicensed Practical Nurse