Provider Demographics
NPI:1992363246
Name:THRASH, LISA MARIE (LPN)
Entity type:Individual
Prefix:
First Name:LISA
Middle Name:MARIE
Last Name:THRASH
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 1:1 E MAIN ST APT 1
Mailing Address - Street 2:
Mailing Address - City:SODUS
Mailing Address - State:NY
Mailing Address - Zip Code:14551-1059
Mailing Address - Country:US
Mailing Address - Phone:315-898-5544
Mailing Address - Fax:
Practice Address - Street 1:313 ERIE ST APT 1
Practice Address - Street 2:
Practice Address - City:FULTON
Practice Address - State:NY
Practice Address - Zip Code:13069-1219
Practice Address - Country:US
Practice Address - Phone:315-898-5544
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2019-06-02
Last Update Date:2019-06-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY260011-1164W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes164W00000XNursing Service ProvidersLicensed Practical Nurse