Provider Demographics
NPI:1730393117
Name:POINSETTE, LISA B (LPN)
Entity type:Individual
Prefix:MRS
First Name:LISA
Middle Name:B
Last Name:POINSETTE
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 1:35 WINDING BROOK DRIVE
Mailing Address - Street 2:
Mailing Address - City:WALDEN
Mailing Address - State:NY
Mailing Address - Zip Code:12586
Mailing Address - Country:US
Mailing Address - Phone:845-778-1252
Mailing Address - Fax:
Practice Address - Street 1:35 WINDING BROOK DR
Practice Address - Street 2:
Practice Address - City:WALDEN
Practice Address - State:NY
Practice Address - Zip Code:12586-2233
Practice Address - Country:US
Practice Address - Phone:845-778-1252
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-05-09
Last Update Date:2007-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY2471411164W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes164W00000XNursing Service ProvidersLicensed Practical Nurse
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY02044920Medicaid