Provider Demographics
NPI:1437472750
Name:PRATT, TIRA LYNN (LPN)
Entity type:Individual
Prefix:
First Name:TIRA
Middle Name:LYNN
Last Name:PRATT
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 1:17 COLEMAN AVE
Mailing Address - Street 2:
Mailing Address - City:SPENCERPORT
Mailing Address - State:NY
Mailing Address - Zip Code:14559-1803
Mailing Address - Country:US
Mailing Address - Phone:585-770-0683
Mailing Address - Fax:
Practice Address - Street 1:17 COLEMAN AVE
Practice Address - Street 2:
Practice Address - City:SPENCERPORT
Practice Address - State:NY
Practice Address - Zip Code:14559-1803
Practice Address - Country:US
Practice Address - Phone:585-770-0683
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2010-03-02
Last Update Date:2010-03-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY282684-1164W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes164W00000XNursing Service ProvidersLicensed Practical Nurse