Provider Demographics
NPI:1992064414
Name:DEREPENTIGNY-PECAK, ANGEL MARIE (LPN)
Entity type:Individual
Prefix:MRS
First Name:ANGEL
Middle Name:MARIE
Last Name:DEREPENTIGNY-PECAK
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 1:16 SIMMONS AVE
Mailing Address - Street 2:
Mailing Address - City:COHOES
Mailing Address - State:NY
Mailing Address - Zip Code:12047-2329
Mailing Address - Country:US
Mailing Address - Phone:518-235-5925
Mailing Address - Fax:
Practice Address - Street 1:16 SIMMONS AVE
Practice Address - Street 2:
Practice Address - City:COHOES
Practice Address - State:NY
Practice Address - Zip Code:12047-2329
Practice Address - Country:US
Practice Address - Phone:518-235-5925
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2012-05-04
Last Update Date:2012-05-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY284063164W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes164W00000XNursing Service ProvidersLicensed Practical Nurse