Provider Demographics
NPI:1033459664
Name:CAPOBIANCO, DANICA M (LPN)
Entity type:Individual
Prefix:
First Name:DANICA
Middle Name:M
Last Name:CAPOBIANCO
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 1:15734 STATE HIGHWAY 8
Mailing Address - Street 2:
Mailing Address - City:SIDNEY
Mailing Address - State:NY
Mailing Address - Zip Code:13838-2700
Mailing Address - Country:US
Mailing Address - Phone:607-435-5941
Mailing Address - Fax:
Practice Address - Street 1:15734 STATE HIGHWAY 8
Practice Address - Street 2:
Practice Address - City:SIDNEY
Practice Address - State:NY
Practice Address - Zip Code:13838-2700
Practice Address - Country:US
Practice Address - Phone:607-435-5941
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2013-02-19
Last Update Date:2013-02-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY309619-1164W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes164W00000XNursing Service ProvidersLicensed Practical Nurse