Provider Demographics
NPI:1588174817
Name:LASSMAN, MELISSA M
Entity type:Individual
Prefix:
First Name:MELISSA
Middle Name:M
Last Name:LASSMAN
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:170 MCCHESNEY ST # 2
Mailing Address - Street 2:
Mailing Address - City:WILSON
Mailing Address - State:NY
Mailing Address - Zip Code:14172-9677
Mailing Address - Country:US
Mailing Address - Phone:716-946-5666
Mailing Address - Fax:
Practice Address - Street 1:170 MCCHESNEY ST # 2
Practice Address - Street 2:
Practice Address - City:WILSON
Practice Address - State:NY
Practice Address - Zip Code:14172-9677
Practice Address - Country:US
Practice Address - Phone:716-946-5666
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2017-09-30
Last Update Date:2022-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY295371164W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes164W00000XNursing Service ProvidersLicensed Practical NurseGroup - Single Specialty