Provider Demographics
NPI:1366758195
Name:CASTELLANO, LISA TIERNEY (RN)
Entity type:Individual
Prefix:
First Name:LISA
Middle Name:TIERNEY
Last Name:CASTELLANO
Suffix:
Gender:F
Credentials:RN
Other - Prefix:
Other - First Name:LISA
Other - Middle Name:TIERNEY
Other - Last Name:ERNST-CASTELLANO
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:RN
Mailing Address - Street 1:41 BRUNSWICK ST
Mailing Address - Street 2:
Mailing Address - City:STATEN ISLAND
Mailing Address - State:NY
Mailing Address - Zip Code:10314-6017
Mailing Address - Country:US
Mailing Address - Phone:718-983-5654
Mailing Address - Fax:718-982-5840
Practice Address - Street 1:41 BRUNSWICK ST
Practice Address - Street 2:
Practice Address - City:STATEN ISLAND
Practice Address - State:NY
Practice Address - Zip Code:10314-6017
Practice Address - Country:US
Practice Address - Phone:718-983-5654
Practice Address - Fax:718-982-5840
Is Sole Proprietor?:Yes
Enumeration Date:2010-08-31
Last Update Date:2010-08-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY349583-1163W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163W00000XNursing Service ProvidersRegistered Nurse