Provider Demographics
NPI:1144551268
Name:PRATT, WAYNE H (LPN)
Entity type:Individual
Prefix:MR
First Name:WAYNE
Middle Name:H
Last Name:PRATT
Suffix:
Gender:M
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:PO BOX 356
Mailing Address - Street 2:
Mailing Address - City:UNION SPRINGS
Mailing Address - State:NY
Mailing Address - Zip Code:13160-0356
Mailing Address - Country:US
Mailing Address - Phone:315-889-7115
Mailing Address - Fax:
Practice Address - Street 1:100 GENESEE ST
Practice Address - Street 2:STAFKINGS HEALTHCARE
Practice Address - City:AUBURN
Practice Address - State:NY
Practice Address - Zip Code:13021-3642
Practice Address - Country:US
Practice Address - Phone:315-889-7115
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2010-01-29
Last Update Date:2010-01-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY187772164W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes164W00000XNursing Service ProvidersLicensed Practical Nurse