Provider Demographics
NPI:1962765602
Name:LACOSSE, TERRY ANN (LPN)
Entity type:Individual
Prefix:MS
First Name:TERRY
Middle Name:ANN
Last Name:LACOSSE
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 1:13265 BELSCHER RD
Mailing Address - Street 2:
Mailing Address - City:SPRINGVILLE
Mailing Address - State:NY
Mailing Address - Zip Code:14141-9235
Mailing Address - Country:US
Mailing Address - Phone:716-592-7997
Mailing Address - Fax:
Practice Address - Street 1:13265 BELSCHER RD
Practice Address - Street 2:
Practice Address - City:SPRINGVILLE
Practice Address - State:NY
Practice Address - Zip Code:14141-9235
Practice Address - Country:US
Practice Address - Phone:716-592-7997
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2012-06-18
Last Update Date:2012-06-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY309674164W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes164W00000XNursing Service ProvidersLicensed Practical Nurse