Provider Demographics
NPI:1487097150
Name:LAND, STEPHANIE M (LPN)
Entity type:Individual
Prefix:
First Name:STEPHANIE
Middle Name:M
Last Name:LAND
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 1:1325 US HIGHWAY 20
Mailing Address - Street 2:APT 3
Mailing Address - City:WEST WINFIELD
Mailing Address - State:NY
Mailing Address - Zip Code:13491-2711
Mailing Address - Country:US
Mailing Address - Phone:315-982-0516
Mailing Address - Fax:
Practice Address - Street 1:1325 US HIGHWAY 20
Practice Address - Street 2:APT 3
Practice Address - City:WEST WINFIELD
Practice Address - State:NY
Practice Address - Zip Code:13491-2711
Practice Address - Country:US
Practice Address - Phone:315-982-0516
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2013-04-12
Last Update Date:2013-04-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY285614164W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes164W00000XNursing Service ProvidersLicensed Practical Nurse