Provider Demographics
NPI:1902906290
Name:ALTON, BARBARA JEAN (LPN)
Entity Type:Individual
Prefix:
First Name:BARBARA
Middle Name:JEAN
Last Name:ALTON
Suffix:
Gender:F
Credentials:LPN
Other - Prefix:
Other - First Name:BARBARA
Other - Middle Name:JEAN
Other - Last Name:NICHOLS
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:LPN
Mailing Address - Street 1:354 BREMM RD
Mailing Address - Street 2:P.O. BOX 148
Mailing Address - City:LACONA
Mailing Address - State:NY
Mailing Address - Zip Code:13083-3127
Mailing Address - Country:US
Mailing Address - Phone:315-387-6238
Mailing Address - Fax:
Practice Address - Street 1:354 BREMM RD
Practice Address - Street 2:
Practice Address - City:LACONA
Practice Address - State:NY
Practice Address - Zip Code:13083-3127
Practice Address - Country:US
Practice Address - Phone:315-387-6238
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-09-25
Last Update Date:2007-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY237214164W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes164W00000XNursing Service ProvidersLicensed Practical Nurse
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY02134774Medicaid