Provider Demographics
NPI:1447673553
Name:BIANCO, CORNELIA (LPN)
Entity type:Individual
Prefix:
First Name:CORNELIA
Middle Name:
Last Name:BIANCO
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 1:121 LAFAYETTE RD
Mailing Address - Street 2:APT.211
Mailing Address - City:SYRACUSE
Mailing Address - State:NY
Mailing Address - Zip Code:13205-2929
Mailing Address - Country:US
Mailing Address - Phone:315-264-5107
Mailing Address - Fax:
Practice Address - Street 1:121 LAFAYETTE RD
Practice Address - Street 2:APT.211
Practice Address - City:SYRACUSE
Practice Address - State:NY
Practice Address - Zip Code:13205-2929
Practice Address - Country:US
Practice Address - Phone:315-264-5107
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2014-01-24
Last Update Date:2014-01-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY290335-1164W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes164W00000XNursing Service ProvidersLicensed Practical Nurse
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY290335-1OtherLPN LICENSE NUMBER