Provider Demographics
NPI:1972093862
Name:LAUCER, ILEANA
Entity type:Individual
Prefix:
First Name:ILEANA
Middle Name:
Last Name:LAUCER
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 1:317 8TH ST APT 1L
Mailing Address - Street 2:
Mailing Address - City:UNION CITY
Mailing Address - State:NJ
Mailing Address - Zip Code:07087-4151
Mailing Address - Country:US
Mailing Address - Phone:201-927-1864
Mailing Address - Fax:
Practice Address - Street 1:317 8TH ST APT 1L
Practice Address - Street 2:
Practice Address - City:UNION CITY
Practice Address - State:NJ
Practice Address - Zip Code:07087-4151
Practice Address - Country:US
Practice Address - Phone:201-927-1864
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2018-05-16
Last Update Date:2018-05-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY8454664164W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes164W00000XNursing Service ProvidersLicensed Practical Nurse