Individual
LISA ANN MICCIO
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
LPN
Contact information
Practice address
764 BIRCHWOOD DR, DUANESBURG, NY 12056-4207
(518) 362-6292
Mailing address
764 BIRCHWOOD DR, DUANESBURG, NY 12056-4207
(518) 362-6292
Taxonomy
Speciality
Code
Description
License number
State
164X00000X
Licensed Vocational Nurse
Primary
165690-1
NY
Other
Enumeration date
07/03/2018
Last updated
07/03/2018
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