Provider Demographics
NPI:1457732935
Name:PRUNIER, AILEEN (LPN)
Entity type:Individual
Prefix:
First Name:AILEEN
Middle Name:
Last Name:PRUNIER
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 1:32 MIDWAY DR
Mailing Address - Street 2:
Mailing Address - City:MONROE
Mailing Address - State:NY
Mailing Address - Zip Code:10950-1128
Mailing Address - Country:US
Mailing Address - Phone:845-774-5750
Mailing Address - Fax:
Practice Address - Street 1:32 MIDWAY DR
Practice Address - Street 2:
Practice Address - City:MONROE
Practice Address - State:NY
Practice Address - Zip Code:10950-1128
Practice Address - Country:US
Practice Address - Phone:845-774-5750
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2015-06-10
Last Update Date:2015-06-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY302605164W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes164W00000XNursing Service ProvidersLicensed Practical Nurse