Provider Demographics
NPI:1366862823
Name:ALLSTON, LARICIA (CNA)
Entity type:Individual
Prefix:
First Name:LARICIA
Middle Name:
Last Name:ALLSTON
Suffix:
Gender:F
Credentials:CNA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:64 ELDER DR
Mailing Address - Street 2:
Mailing Address - City:MASTIC BEACH
Mailing Address - State:NY
Mailing Address - Zip Code:11951-6323
Mailing Address - Country:US
Mailing Address - Phone:631-399-2149
Mailing Address - Fax:
Practice Address - Street 1:64 ELDER DR
Practice Address - Street 2:
Practice Address - City:MASTIC BEACH
Practice Address - State:NY
Practice Address - Zip Code:11951-6323
Practice Address - Country:US
Practice Address - Phone:631-399-2149
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2014-04-23
Last Update Date:2014-04-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY342016270803E376K00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes376K00000XNursing Service Related ProvidersNurse's Aide