Provider Demographics
NPI:1033555149
Name:RAMOS, THERESA DORA (LPN)
Entity Type:Individual
Prefix:
First Name:THERESA
Middle Name:DORA
Last Name:RAMOS
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 1:55 PINE DR
Mailing Address - Street 2:
Mailing Address - City:BLOOMINGBURG
Mailing Address - State:NY
Mailing Address - Zip Code:12721-4829
Mailing Address - Country:US
Mailing Address - Phone:845-800-3259
Mailing Address - Fax:
Practice Address - Street 1:55 PINE DR
Practice Address - Street 2:
Practice Address - City:BLOOMINGBURG
Practice Address - State:NY
Practice Address - Zip Code:12721-4829
Practice Address - Country:US
Practice Address - Phone:845-800-3259
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2013-05-15
Last Update Date:2013-05-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY285187-1164W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes164W00000XNursing Service ProvidersLicensed Practical Nurse